Urodynamics and Incontinence

Center for Urodynamics and Incontinence

Columbia's Division of Pediatric Urology offers a state-of-the-art Center for Urodynamics and Incontinence at NewYork-Presbyterian/Morgan Stanley Children's Hospital, where we treat children with incontinence and other conditions that affect bladder function. The center is one of only a few facilities where children with incontinence can go for comprehensive testing and treatment, particularly for X-ray images of the bladder that record bladder pressure measurements in specialized test called a video urodynamic examination. Patients suspected of having serious bladder problems, or known to have anorectal malformation, neurogenic bladder,  spina bifida, cerebral palsy, or wetting problems linked to a condition called vesicoureteral reflux are more likely to have this evaluation. The center treats approximately 150 children with neurogenic bladder and prides itself on its proactive mission to prevent permanent kidney and bladder damage in these children.

Diagnosis and Treatment

Our philosophy emphasizes non-invasive investigations of the child with incontinence whenever possible. At the same time, though, we aggressively treat the condition to prevent future bladder damage. The majority of our patients have wetting problems without a neurologic or serious anatomic cause. This type of incontinence is common in children, but many are left untreated. Minor causes of wetting can lead to later severe consequences, so children with incontinence should be evaluated by a pediatric urologist as early as possible. An early evaluation is important for the child's self-esteem and social interactions but also because the cause of incontinence can lead to permanent damage of the bladder or even the kidneys. It can also lead to lifelong problems with frequency and urgency in people who were untreated as children.

Many parents and even some pediatricians are surprised to hear that the root of the problem is physical and not psychological. Identifying the physical source takes time, since children with nearly identical symptoms may have completely different underlying disorders, each with its own therapeutic regimen. The most common problem among these children is their tendency to squeeze the pelvic floor muscles during urination when they should be relaxing them. The bladder muscles contract normally to expel urine. When the pelvic floor muscles tighten up at the same time, it becomes difficult for the bladder to empty. When the bladder does not empty, bladder pressure increases and the child must make another urgent trip to the bathroom. Using a variety of biofeedback techniques including computerized games, we teach children how to control and coordinate their muscles during urination. In as few as three one-hour biofeedback sessions, we can correct uncoordinated voiding. It is very satisfying to see children leave the Center dry with newly restored self-esteem.