From the Guidelines
The treatment of voiding dysfunction should begin with conservative approaches, including behavioral modifications like timed voiding, double voiding, and pelvic floor exercises, as well as fluid management and bowel programs, as recommended by the International Children's Continence Society 1.
Key Considerations
- The specific type and underlying cause of voiding dysfunction should be accurately diagnosed to guide treatment decisions.
- Conservative approaches, such as urotherapy and muscle retraining, should be attempted before progressing to medications or procedures.
- Fluid management, including limiting caffeine and alcohol, can help alleviate symptoms.
- Bowel programs, including management of constipation, are essential in treating voiding dysfunction.
Treatment Options
- Behavioral modifications:
- Timed voiding
- Double voiding
- Pelvic floor exercises (Kegels)
- Fluid management:
- Limiting caffeine and alcohol
- Adequate hydration
- Bowel programs:
- Management of constipation
- Bowel training
- Medications:
- Anticholinergics (e.g., oxybutynin, tolterodine, solifenacin) for overactive bladder
- Alpha-blockers (e.g., tamsulosin) for underactive bladder or retention
- Advanced treatments:
- Botulinum toxin injections for refractory overactive bladder
- Percutaneous tibial nerve stimulation
- Sacral neuromodulation
- Surgical interventions (e.g., sling procedures, augmentation cystoplasty) for severe cases
Monitoring and Follow-up
- Regular follow-up is essential to monitor treatment efficacy and adjust therapy as needed.
- Treatment success depends on accurate diagnosis of the underlying dysfunction type, as therapies for overactive and underactive bladder differ significantly.
- The use of prompted voiding and individualized bladder-training programs can be beneficial in managing voiding dysfunction, particularly in patients with neurological disorders 1.
From the FDA Drug Label
Oxybutynin chloride is indicated for the relief of symptoms of bladder instability associated with voiding in patients with uninhibited neurogenic or reflex neurogenic bladder (i.e., urgency, frequency, urinary leakage, urge incontinence, dysuria). Finasteride tablets was initially evaluated in patients with symptoms of BPH and enlarged prostates by digital rectal examination in two 1-year, placebo-controlled, randomized, double-blind studies and their 5-year open extensions Symptoms were quantified using a score similar to the American Urological Association Symptom Score, which evaluated both obstructive symptoms (impairment of size and force of stream, sensation of incomplete bladder emptying, delayed or interrupted urination) and irritative symptoms (nocturia, daytime frequency, need to strain or push the flow of urine)
The treatment of voiding dysfunction can be managed with oxybutynin for symptoms of bladder instability associated with voiding, or with finasteride for symptoms of BPH.
- Oxybutynin is indicated for the relief of symptoms of bladder instability associated with voiding in patients with uninhibited neurogenic or reflex neurogenic bladder.
- Finasteride has been shown to improve symptom score and reduce the risk of acute urinary retention and surgery in patients with BPH. 2 and 3
From the Research
Treatment Options for Voiding Dysfunction
- Voiding dysfunction can be treated with various approaches, including conservative measures such as pelvic floor muscle training, oral medication, and clean intermittent catheterization 4
- Surgical approaches can also be used to manage concomitant or isolated urinary incontinence 4
- Urotherapy and biofeedback are first and second-line treatments for dysfunctional voiding, respectively, and can lead to significant improvement or cure in the majority of patients 5
- Additional therapy options for refractory patients include α-blockers, botulinum injection, and electroneurostimulation 5
Pelvic Floor Physical Therapy
- Pelvic floor physical therapy (PFPT) is a program of functional retraining to improve pelvic floor muscle strength, endurance, power, and relaxation in patients with pelvic floor dysfunction 6
- PFPT can improve or cure symptoms of urinary incontinence, pelvic organ prolapse, fecal incontinence, and hypertonic pelvic floor disorders 6
- PFPT has robust evidence-based support and clear benefit as a first-line treatment for most pelvic floor disorders 6
Behavioral and Physical Therapies
- Behavioral and physical therapies, including pelvic floor muscle training (PFMT), have been used to treat incontinence and overactive bladder 7
- PFMT is effective for incontinence, as well as urgency, frequency, and nocturia, and can be combined with other treatment modalities 7
- PFMT holds potential for prevention of bladder symptoms 7