Overactive Bladder in Children

Abstract

Overactive bladder (OAB) is clinically defined as the presence of urinary urgency and may be associated with diurnal urinary incontinence, frequency, and enuresis, and/or constipation. In children aged 5–10 years, the prevalence is 5–12%. Association with emotional disorders is widely described in the literature. Constipation is associated with voiding symptoms because of crosstalk between the gastrointestinal tract and the urinary tract. OAB is believed to be multifactorial. Correct functioning between the pontine micturition centre, the periaqueductal grey matter, anterior cingulate gyrus, and prefrontal cortex is important for correct voiding development and the process of maturation. Patients with OAB have greater anterior cingulate gyrus activity and deactivation of the pontine micturition centre urinary inhibition process, leading to a greater frequency of bladder repletion sensation. Urotherapy is the first treatment to be initiated and aims to change behavioural patterns inthese patients. Other treatment options are anticholinergics, with oxybutynin being the most widely studied, but also described is the use of tolterodine, darifenacin, and mirabegron. Alternative treatments, such as nerve stimulation in the parasacral or the posterior tibial area, have shown improvement of symptoms in comparative studies with conventional drug treatment, and, in refractory cases, botulinum toxin A is an option. In this article, we review the pathophysiology, associated conditions, and aspects related to diagnosis and treatment of OAB.