![]() However, in my personal experience it is often associated with these two manifestations, and in many instances girls with postvoid dribbling have recurrent courses of vulvar pruritus and vaginal discharge that respond favourably to simple measures recommended for patients with vaginal reflux. Vaginal reflux has not been identified as a cause of other urinary or local symptoms, such as vulvar pruritus or recurrent vulvovaginitis. These girls characteristically present postvoid dribbling, usually in the minutes following normal micturition, when they get off the toilet and start to more around. The key to diagnosis is an appropriate history-taking, which ideally would be a structured history based on a questionnaire, as it is common for parents or girls to ignore the symptoms or fail to report them properly. 3Īlthough the absence of anatomical abnormalities is one of the diagnostic criteria for vaginal reflux, in my experience and that of other authors there are girls that have minor anomalies, such as hypospadias, labial fusion or labial redundancy that make it easier for urine to pool in the vagina. Obesity was a statistically significant risk factor in this group of girls, a fact that has been documented by other authors. They also found that patients with vaginal reflux were diagnosed at older ages, had a higher body mass index, and in two cases had labial fusion. 1 that analysed 39 girls with daytime urinary incontinence, the most frequent cause of the incontinence was vaginal reflux. In the case series presented by Bernasconi et al. In fact, the actual incidence of vaginal reflux as a cause of urinary incontinence is not known. As happened in the cases described by these authors, it is not unusual for the diagnosis to be made after a series of tests 5 or after treatment for urinary incontinence has failed. 5 in the current issue of this journal evince that while vaginal reflux is a known cause of urinary incontinence in prepubertal girls, it sometimes goes undetected. The three cases reviewed by Fernández Ibieta et al. Symptomatic vaginal reflux, or reflux causing urinary incontinence, is defined as incontinence manifesting in girls with sphincter control that leak urine within 10 min from spontaneous emptying, with normal micturition and without evidence of anatomical abnormalities in the physical examination. However, the pooling of urine in the vagina during micturition is a well-known phenomenon in both girls and women, and it does not always lead to urinary incontinence. It affects girls that experience urine leaks in the minutes following voiding and is not associated with other symptoms. Vaginal or urethrovaginal reflux is seen as a minor cause of urinary incontinence. Occasionally, when incontinence is associated with other symptoms of lower urinary tract dysfunction, other diagnostic tests are indicated to assess bladder anatomy and/or functioning, such as urodynamic or videourodynamic tests, and at times even cystourethrography. The diagnostic approach to daytime urinary incontinence in girls without neurological disorders is essentially based on the medical history, physical examination, voiding diary and noninvasive urodynamic tests. Furthermore there may be an effect on the patient's social life and/or sexual function.Urinary incontinence is a common reason for care-seeking in the paediatric population that is more prevalent in girls and is found in 3–12% of children 6–8 years of age and in 1–12% of children 10–12 years of age. The patient may be using pads to self-manage her symptoms and may be restricting fluid intake. Severity may be assessed by asking the patient when incontinence occurs and whether there is an activity that precipitates it. ![]() It is important to assess the severity of incontinence and its impact on quality of life. ![]() For example, constipation, obesity, diabetes, alcohol and high fluid intake may be relevant. When evaluating urinary incontinence, the cause may be apparent and there may be pre-existing factors responsible. 2 Involuntary detrusor contractions (spontaneous or provoked) that may be observed on urodynamic studies are known as detrusor overactivity. ![]() This usually presents with increased frequency and nocturia. Overactive bladder syndrome (OAB) may cause urge urinary incontinence. Mixed urinary incontinence occurs when stress and urge urinary incontinence co-exist. 1 Stress urinary incontinence refers to involuntary leakage of urine on effort or exertion whereas urge urinary incontinence refers to involuntary leakage of urine that is associated with or preceded by a sudden desire to pass urine. Urinary incontinence is more prevalent in women than men with an increasing incidence with advancing age. Urinary incontinence describes involuntary leakage of urine. ![]()
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