ABSTRACT
Overactive bladder (OAB) is second in prevalence only to isolated nocturnal enuresis as a voiding complaint in children.1-4 Bladder overactivity and urge incontinence may predispose children to urinary tract infections and renal injury.5,6 The hallmark symptom of OAB in children is urgency, and children with this symptom can clinically be diagnosed with an OAB based on a definition by the International Children’s Continence Society (ICCS).7 A study of the micturition habits of 3556 normal 7-year-old Swedish children entering school showed that 21% of girls and 18% of boys had moderate to severe urinary urgency, and 10 years later only 5.9% of girls and 0.9% of boys reported urgency, daytime incontinence, emptying difficulties, or enuresis.2,3 Urge incontinence is often coupled with OAB, and is associated with psychosocial implications. Up to 20% of 4-6-year-old children experience occasional daytime wetting, although only 3% have wetting accidents twice or more weekly.8 The prevalence of daytime wetting in children appears to decrease with increasing age, and occurs at least once every two weeks in 10% of 5-6 year olds, 5% in those from 6 to 12 years, and only 4% from 12 to 18 years of age.4 Of symptomatic children evaluated by urodynamic study, detrusor overactivity occurs in 52-58%,5,9 as opposed to the low incidence of 5-18% in asymptomatic children.10,11
The challenge to the clinician is to attempt to separate a pathologic pattern of urgency and
incontinence from the natural timing of acquisition of toilet training.
