H.K., a 5years old girl was brought with complaints of frequency of urination and wetting on and off during the daytime. She was dry at night time.
On further questioning she was well till about 3 years of age when she developed frequency of urination and constipation. She had 2 attacks of urinary infections which were treated by her pediatrician. She used to run to the toilet and still sometimes leak in the undergarments. Detailed history also revealed her habit of squeezing the legs or sometimes sitting in the corner with heel pressed into the perineum (Vincent’s Curtsy). The problems had worsened over the last one year. That is why she was referred to a Pediatric urologist clinic.
On examination H.K. was a cheerful and shy 5 year old girl. Her spine examination was normal and lower limbs were also normal. Rest of examination was also normal. Ultrasound and urine examinations were also normal. Spine x-ray was normal but it showed a loaded colon suggestive of constipation. A urodynamic study was showed hyperactive bladder with uninhibited contractions and high pressures. The bladder capacity was also less for age.
She was started on anticholinergic medicines and also medicines for constipation. Her diet was also modified to have more roughage to prevent constipation. The dose was adjusted over a period of next two weeks till she was dry for three hours. She has done well and now at three months she is being gradually tapered off the Anticholinergics.
Dr A.K.Singal is an expert & top Pediatric urologist and is best known for treating children with wetting, incontinence and urinary infections. He is available in his clinics in Navi Mumbai, India.
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