Functional Voiding Disorders In Children.

the purpose of efficient storage, the bladder has the ability to stretch as a watertight reservoir. It is equipped with adequate sphincter continence and an ability to inhibit spontaneous contractions. Contraction of detrusor muscles along with relaxation of the internal and external sphincters is necessary for micturition. The functions of the bladder are controlled by a complex integration of autonomic and somatic nervous system as depicted in Fig. 1. The somatic and the central nervous system ensure cortical control of voiding, thus preventing enuresis. Coordinated and complete urine release depends on intact innervation. Autonomic innervations to the urinary bladder accomplishes this through parasympathetic and sympathetic pathways. The sympathetic system is responsible for effective bladder filling and the parasympathetic system for micturition. Somatic nerves innervate the striated muscles of the bladder outlet. Coordinated voiding results from viscerosomatic integration between these autonomic and somatic pathways [1]. The central mechanisms influencing urinary tract function are organised as a simple on-off switching circuit with a reciprocal Introduction In higher vertebrates, nature interposed the urinary bladder between the kidneys and the external environment to allow continence. The bladder functions as a storage organ that can empty to completion at an appropriate time and place. At times problems relating to the bladder are obvious as in an incontinent, dribbling child where the problem may be due to an anatomical or neurological anomaly. But at other times they may not be so obvious and children present to the paediatrician, with problems such as recurrent urinary tract infections or nocturnal enuresis with daytime symptoms. Under such circumstances it is important to consider a possible functional voiding disorder and evaluate the child. Early intervention may prevent renal damage due to retrograde effects of high pressure within the bladder. Managing these children requires an understanding of the functioning of the urinary bladder.