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Bladder control


Question

Our child, successfully toilet trained for many years, is suddenly having problems with bladder control. Is there any connection to his approaching puberty?

Answer of our experts

The fact that this just began suddenly after years of being dry is concerning. He should have a urinary tract infection ruled out first (via a sample of urine sent for culture). If this is positive, he should have a renal (kidney) ultrasound, if not previously done, and a voiding cystourethrogram to demonstrate his internal anatomy and make sure there is no predisposition to a urinary tract infection. I would also make sure that there is no sexual abuse going on, since a sexually transmitted disease (possible to test for by cultures) could present with incontinence (lack of bladder control). A careful neurologic evaluation (physical examination) should be done to rule out a spinal cord problem (e.g. tethered spinal cord) and a spinal study performed, if needed. Finally, if all of this is negative it could be behavioral (anxiety, attention-seeking, etc.) and this could be addressed at home or with a behavioral psychologist.

TK 7-13-10

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Recommendation(s)

Pain and Behaviour

R18
As pain can easily remain unrecognised in a child with CdLS, all care providers should be aware of the different manifestations and the possible sources of pain. Specific tools to assess pain are recommended.

Recommendation(s)

Anxiety

R59
Interventions targeting problematic repetitive behaviour in individuals with CdLS should be sensitive to anxiety, sensory problems and social demands. These interventions should also consider environmental factors.
R60
Atypical presentation of anxiety and mood disorder should be considered when behaviour changes occur.
R61
As anxiety is common in individuals with CdLS during periods of environmental change/transitions, a planned program should be implemented.
R62
Treatment of anxiety and mood disorders in individuals with CdLS should be considered using psychosocial interventions (therapies) and pharmacotherapy (medication).

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