Overactive Bladder in Children. Part 2: Management

Purpose

The management of pediatric overactive bladder syndrome has relied primarily on anticholinergics and a bowel regimen. In many cases the results have been ineffective and they have frustrated many parents, patients and practitioners. We explored other treatment modalities that may be more effective than the regimens that we currently use. A thorough understanding of the causes of overactive bladder syndrome are essential to help us find the appropriate treatment for individuals.

Materials and Methods

We looked at numerous treatment modalities that are being used for overactive bladder syndrome and matched them to a specific cause of overactive bladder syndrome that would be best suited to treat the problem. The treatment of constipation as a mainstay for pediatric overactive bladder syndrome was explored as well as its different options. New treatment modalities involving electrical stimulation were explored as well as botulinum A toxin injections.

Results

The effectiveness of each treatment was assessed, thereby providing the reader with a foundation for choosing the appropriate treatment.

Conclusions

The treatment of pediatric overactive bladder syndrome is not as simple as placing children on anticholinergics and, if there is no response, simply saying that they will outgrow it. The causes of overactive bladder syndrome are multifactorial and a better understanding of the pathophysiology will allow us to target treatments appropriately for individuals.

Key Words: bladder, urinary bladder, overactive, physiopathology, constipation

Abbreviations and Acronyms: 5-HT, serotonin, AC, cingulate gyrus, ACC, anterior cingulate gyrus, DSD, detrusor-sphincter dyssynergia, EMG, electromyography, OAB, overactive bladder syndrome, PCC, posterior cingulate gyrus, UTI, urinary tract infection