What in the brain/spine could cause a child to be incontinent?

I have an 11 year old son who has been seen by a urologist for incontinence.  The urologest put him on Detrol 1mg bid to help with his overactive bladder.  He told me that my son was having contractions in his bladder that his brain was unable to control.  He told me that most children out grow this but if anything my son has gotten worse.  He is now sending my son to see a neurologist to find out if there is an underlying reason why his brain can't control these contractions.  At this appointment I was also asked if my son has trouble with his handwritting.  My son's handwritting is awful.  He is now in the 6th grade, and the amount of writting he has to do has more than doubled from last year, and he is dropping his grades because the teachers have trouble reading what he has written.

So I guess my question is:  
What do these two things have in common?  What could be causing this?  He has allways been incontinent (small amounts) from... 3 years old.. when he stopped wearing diapers.

Here are some other things (don't know if they help or not):
He is farsighted with astygmatisim (spelling?)
He has Brown's syndrome
He is VERY short for his age (3ft 11in).  At 3 years of age he had a bone growth of a 2 year old.
Most of the boys in his class are 'starting' to hit puberty, while my son still apears like a child.  His genitals are very small.


I thank you for any help/direction you can give me.  And I thank you for taking the time to read all this.

Danyelle

[CCF Neuro[P] MD, RPS]

Dear Danyelle:

Sorry to hear about your son's bladder.  It is difficult to tell you what is occuring.  Does your son have daytime dryness?  Does he control his bladder at all?  In many cases where the child is otherwise fairly normal and there is some daytime dryness and only nightime enuresis, the bladder volume is limited and the child has accidents.  We have seen this in 18 year olds (1% of the population has night time accidents, usually males).  The treatment for this is behavior modification to try and expand the bladder.  I am assuming that all etiologies were investigated such as a tethered cord, myelomeningocele, etc and these were negative.  That he can also concentrate his urine.  A neurological consult is probably not a bad idea if these issues above were not addressed or if on neurological examination there is a focal deficit.  Brown's syndrome is only of the eye muscle, delayed puberty may indicate that maturation of the inhibition process of the brain is alittle delayed and may account for some of the incontinence.  Without examining him, I can't tell.  

I would say, that higher on the list is an immature bladder with a small volume.  There might be a neurological problem if a tethered cord, myelomeningocele or abnormal neurological exam is found.  However, I would bet on the immature bladder.  This is what we see most of, but one has to rule out the other stuff.

Sincerely,

CCF Neuro MD

[Danyelle]

Thank you very much for attention. :)

I guess I should have gone into alittle more detail.  He is incontinent of small amounts all day long.  He says that he doesn't know he has to void until some of it comes out, then he only has a few minutes at the most to make it to the bathroom.  He also has times where he is unable to start a stream, and can go 12hrs or more without voiding.  He has been known to void into containers in his room at night because he can't make it to the bathroom in time, but he has never really wet his bed, just his underwear.  His urodynamic studies showed a normal sized bladder with a normal sized volume (250ml).  We have tried a bladder training program without success.  Because he can't allways start the stream when he wants he can try to void and not be able to go, but then 5mins-20mins later he is leaking, so going to the bathroom every 2 hours doesn't seem to help him.

He has not had any of the things ruled out that you spoke about.  

I thank you very much again for your time.

[marcia]

Danyelle..I can't help with the medical problems..but maybe with some of the school problems. I am a teacher..and quite sensitive to the problems of kids that are a bit different, as I also have a handicapped child.
You mentioned his writing was poor.  See if you can talk to the teachers +/or the counselor and arrange for a lot of his work to be done on computer.  By typing..he will resolve the bulk of his handwriting difficulties with the teachers. This skill is required of kids today anyway...and handwriting...as far as others having to read it..is becoming a thing of the past. It will not solve the handwriting problem in math class...but maybe the math teacher will be understanding and supportive.
The next few years will be important for your son to succeed, as his self esteem is building...and we all know how difficult the teen years can be...even on a regular day!!!Good luck.

[CCF Neuro[P] MD, RPS]

Dear Danyelle:

Let us know how the neurology vist goes.

CCF Neuro MD

[Eurico]

Danyelle,

My daughter had a tethered spinal cord from a fatty filum (lower part of the spinal cord) and bladder and bowel control problems. I'd ask that a full spine MRI be done to rule this out.

Does your son have a mark, dimple or indentation at the base of his spine? I'm not sure that it's always easy to see if there is one. If so, it may be indicative of a spinal cord problem. Nonetheless, an MRI is required to rule this out.

Our daughter was misdiagnosed with Brown Syndrome due to "lazy eye" symptoms. She was diagnosed with Chiari I malformation a few years later and the oculomotor problems vanished with surgery.

Good luck.

Eurico

[CCF Neuro[P] MD, RPS]

thanks for the comments.

CCF Neuro MD