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Urology (Expert Forum)
Bladder Retraining and use of Ditropan
Questions in the Urology forum are answered by Dr. Stephen Liroff, affiliated with the Henry Ford Hospital. Topics covered include benign prostate disease, penis curvature, cystisis, kidney stones, pediatric urology, prostate, sexual dysfunction, urinary tract infections (UTI), and urological cancers.
Bladder Retraining and use of Ditropan
by Janice, Sep 30, 1999 12:00AM
My 5 year old daughter has been struggling with leaking and general bladder continence for over 2 years now. She was put on the bladder retraining program at Toronto's Sick Kids Hospital about 1 1/2 years ago with little success. She has had some periods of dryness, but shortly after has always regressed again.
The program she is on says to take her to void every 2-3 hours and have her double void each time, and if she really needs to go in between these times she may go. At first she wasn't voiding completely but now she seems from the last flow rate test that, that is no longer a problem. She had constant bladder infections at the beginning, but for the last year or so she has been a lot better, but now again she is getting very frequent mild bladder infections. Along with her going to void at the times stated above we would send her to go if her pants were wet. I am now not sure if that was the right thing to do, as I was reading on other bladder retraining web sites that to improve bladder efficiency you need to try and hold it if your bladder starts to contract before it is full. On her last flow rate test she had the urge to void when she only had about 85 ml of urine in her bladder, which is a very small amount for her age. Because of this the doctor recommended putting her on Ditropan, but I am not sure that I want to go to using drugs to solve this problem as it says it is not recommended for children under the age of 5, and she is just almost 5 but is quite small for her age, she is 41 inches tall and 34 lbs. The other web sites had for adult bladder retraining, the patient would try and hold the urge to void for 5 -15 minutes to try and increase the amount the bladder would hold, and retrain it to hold the correct amount of urine. Is this method not good for young children? Any suggestions would be greatly appreciated.
The program she is on says to take her to void every 2-3 hours and have her double void each time, and if she really needs to go in between these times she may go. At first she wasn't voiding completely but now she seems from the last flow rate test that, that is no longer a problem. She had constant bladder infections at the beginning, but for the last year or so she has been a lot better, but now again she is getting very frequent mild bladder infections. Along with her going to void at the times stated above we would send her to go if her pants were wet. I am now not sure if that was the right thing to do, as I was reading on other bladder retraining web sites that to improve bladder efficiency you need to try and hold it if your bladder starts to contract before it is full. On her last flow rate test she had the urge to void when she only had about 85 ml of urine in her bladder, which is a very small amount for her age. Because of this the doctor recommended putting her on Ditropan, but I am not sure that I want to go to using drugs to solve this problem as it says it is not recommended for children under the age of 5, and she is just almost 5 but is quite small for her age, she is 41 inches tall and 34 lbs. The other web sites had for adult bladder retraining, the patient would try and hold the urge to void for 5 -15 minutes to try and increase the amount the bladder would hold, and retrain it to hold the correct amount of urine. Is this method not good for young children? Any suggestions would be greatly appreciated.
Doctor's Answer
by HFHS M.D.-CK, Oct 01, 1999 12:00AM
Dear Janice,
Daytime incontinence in a young girl may have several causes. As you have mentioned, urinary tract infections should be controlled first before other treatments are used. A non neurogenic neruogenic bladder (Hinman's Syndrome) involves a problem with the child delaying urination until it finally passes uncontrollably. Trully neurologic problems such as an occult spina bifida should also be considered.
Your daughter was documented to have a small bladder capacity. It would be important of know the pressures in the bladder during filling and emptying (urodynamics). If the pressures in the bladder are greater than 40cm of water pressure during filling, kidney damage may occur. The treatment for this could include ditropan to relax (decrease the pressure) the bladder preventing kidney damage and possibly decrease leakage episodes. A bladder retraining protocol that involves ignoring urges to urinate could potentially lead to kidney damage if bladder pressures are allowed to rise excessively.
This information is provided for general medical information purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available through our department at the Henry Ford Hospital and its suburban locations (I-800-653-6568).
Sincerely;
HFHS M.D.-CK
Daytime incontinence in a young girl may have several causes. As you have mentioned, urinary tract infections should be controlled first before other treatments are used. A non neurogenic neruogenic bladder (Hinman's Syndrome) involves a problem with the child delaying urination until it finally passes uncontrollably. Trully neurologic problems such as an occult spina bifida should also be considered.
Your daughter was documented to have a small bladder capacity. It would be important of know the pressures in the bladder during filling and emptying (urodynamics). If the pressures in the bladder are greater than 40cm of water pressure during filling, kidney damage may occur. The treatment for this could include ditropan to relax (decrease the pressure) the bladder preventing kidney damage and possibly decrease leakage episodes. A bladder retraining protocol that involves ignoring urges to urinate could potentially lead to kidney damage if bladder pressures are allowed to rise excessively.
This information is provided for general medical information purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available through our department at the Henry Ford Hospital and its suburban locations (I-800-653-6568).
Sincerely;
HFHS M.D.-CK
