Division of Urology

DOVE Center for Voiding, Bladder Function Problems

The DOVE Center at The Children's Hospital of Philadelphia is among the largest, most comprehensive clinics in the U.S. devoted to pediatric bladder and urinary tract dysfunction. Our program treats children with daytime or nighttime wetting, urinary urgency, frequency, and/or constipation. Additionally, we work with children who have recurrent urinary tract infections.

About us
Why do children wet?
The first appointment
Diagnostic tools
Treatment
Make an appointment

About us

DOVE stands for Dysfunctional Voiding Outpatient Evaluation center. Our DOVE team includes urologists, nurse practitioners, nurses and psychologists. We are the only pediatric urology program in the nation with a full-time and a part-time psychologist dedicated to helping children with day- and night-time wetting. Dysfunctional voiding is not usually caused by emotional factors, but it can take an emotional toll on children and their families. The psychologist assists families in finding ways to integrate the treatment plan into their daily lives so that a successful outcome is likely.

Why do children wet?

There are many reasons why children wet. Many do not want to stop fun activities to go to the bathroom. Some children urinate only two or three times a day — they simply are too busy to go to the bathroom until it is too late and then they cannot make it to a toilet in time. Other children have uncontrolled bladder contractions that make them feel like they need to go to the bathroom "right now!"

Still, other children do not fully empty their bladder when they do go to the bathroom, putting them at risk for urinary tract infections. Children who wet only at night wet for completely different reasons. Children do not generally wet out of laziness, emotional problems or inappropriate toilet training.

Sorting out why your child wets, and developing a plan to make the wetting stop, is the goal of the DOVE team.

The first appointment

A DOVE physician or nurse practitioner (a nurse with an advanced degree) will take a thorough history and provide a physical examination of your child. In addition, we will want to know how often your child goes to the bathroom, how often he or she has accidents, and whether your child has a history of urinary tract infections. We will conduct a physical examination of the abdomen, spine and genitals. Contact us at 215-590-2754 to make an appointment at any of our locations.

Diagnostic tools

We may recommend one or more of the following tests:

X-ray of the abdomen (also known as a KUB)

This x-ray helps us determine if your child is constipated, as incontinence and constipation often occur together. We often find that children who seem to have regular toilet habits are actually constipated. Clearing up the constipation can lead to a dramatic improvement in wetting.

Uroflow

Your child will void into a special uroflow chair that measures the urine flow rate and the time needed to empty the bladder. After that, we will check for any urine left in the bladder with a special ultrasound called a bladder scan. Your child needs to come to the appointment with a full bladder to get accurate results.

Ultrasound of the kidneys and bladder

This painless procedure assesses the size and shape of the kidneys and looks for bladder abnormalities.

Video urodynamic study

This study is recommended when a more thorough bladder evaluation is deemed necessary. A special catheter is placed into the bladder to measure the pressure while the bladder is filled with fluid. A soft catheter is also placed in the rectum to measure the abdominal pressure on the bladder. We apply sticky electrodes on your child's bottom to measure their sphincter (hold-on muscle) activity. Periodic x-rays are obtained throughout the study so we can look for bladder abnormalities. Once the child's bladder is full and he or she can no longer hold urine in, the child will void into a special uroflow chair to evaluate the urine flow rate and the time needed to empty the bladder.

Voiding CystoUrethroGram (VCUG)

We may recommend this study if your child had a urinary tract infection and a fever. A catheter is inserted into the bladder, which is filled with fluid that can be seen by x-ray. This study can determine if there is vesicoureteral reflux, a condition where urine backs up toward the kidney. Reflux may persist in the presence of dysfunctional voiding patterns and may cause a bladder infection to wash back up into the kidney. Reflux can cause kidney infections (pyelonephritis), which can lead to permanent damage to the kidneys.

Treatment

Based on the results of your child's evaluation, we may suggest:

Changes in voiding/stooling habits

We commonly recommend that children start stool softeners in order to treat any underlying constipation. We will also request that parents help children structure their schedule so that they are making attempts to void and stool regularly throughout the day.

Increasing fluid intake.

Frequently, we find that children are not drinking enough water throughout the day. In an effort to control the wetting, families sometimes discourage the consumption of fluids. However, it is important that your child be taught to drink water throughout the day. We will explain to your child why drinking water is important and make recommendations as to how much water your child should drink each day.

Biofeedback

Biofeedback training is a way to teach your child to relax the pelvic floor muscles so that the bladder can fully empty. Small sticker electrodes are attached to the child's abdomen and buttocks. The electrodes are connected to a computer. Our nurses will teach your child to perform Kegel exercises while viewing a computer monitor that shows the child's muscle activity.

The initial training session takes about 90 minutes and each session after that is 45 to 60 minutes. Initially, we may recommend that you bring your child back every 2 to 4 weeks. As your child learns the techniques and improves voiding habits, we may recommend sessions further apart. Most children require a minimum of 3 biofeedback sessions.

Behavior modification.

Psychologists work with children and their parents to provide education as to how the body works and why children need to follow the recommendations given. We work with parents to set reasonable expectations and help set up structure and routines. Our psychologists will discuss behavior management around toileting, including how to effectively use incentives, rewards, and natural consequences when the child is not doing his or her part.

Many children we see have other mental health or behavioral issues that make treating their wetting more challenging. Our psychologists will work with parents to treat the voiding problems and can help facilitate referrals to outside mental health professionals to help the child work on learning, emotional, or behavioral issues, if applicable.

Medication

We use medications most frequently to treat frequent urinary tract infections, for children with overactive bladder, and for children with nighttime wetting.

Make an appointment

Our friendly and efficient office staff will help you find what you need and provide outpatient appointments at our main campus in Philadelphia as well as our Pennsylvania satellites in King of Prussia, Exton and Chalfont; and at our New Jersey satellites in Voorhees, Mays Landing, and in Princeton. Contact us at 215-590-2754 to make an appointment at any of our locations.