DOVE Center for Voiding and Bladder Function
The DOVE nurse practitioner was wonderful. My child is proud of what she has accomplished working with the nurse practitioner.
About the DOVE Center
The DOVE (Dysfunctional Outpatient Voiding Education) 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 DOVE team includes urologists, nurse practitioners, nurses and psychologists. 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 (UTIs).
There are many reasons why children have wetting accidents. 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 will take a thorough history of your child’s symptoms and other medical conditions. In addition, we will want to know how often your child goes to the bathroom, how often he has accidents, and whether he has a history of urinary tract infections. It is helpful to bring a record of your child’s recent bathroom habits, using this voiding diary, to the first appointment.
We will also 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.
After meeting with you and your child, we may recommend one or more of the following tests:
- 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.
- 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 children who seem to have regular toilet habits are actually constipated. Treating the constipation can lead to a dramatic improvement in wetting.
- 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 (VUDS) - We recommended this study 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 her sphincter (hold-on muscle) activity. Periodic X-rays are obtained throughout the study so we can look for bladder abnormalities. Once your child's bladder is full and she can no longer hold urine in, she will void into a special uroflow chair, described above, to evaluate the urine flow rate and the time needed to empty her bladder.
- Voiding cystourethrogram (VCUG) - We may recommend this study if your child had a urinary tract infection and a fever at the same time. 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.
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 work with parents to help them develop a schedule with their child that incorporates regular voiding and stooling throughout the day.
- Increasing fluid intake - Families often restrict fluids to help control the wetting. However, it is important to teach your child 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 she should drink each day.
- Biofeedback - Biofeedback training is a way to teach your child to relax the pelvic floor muscles so his bladder can empty completely. During the session, we place small sticker electrodes on your child's abdomen and buttocks. The stickers have wires connected to a computer. A nurse will teach your child to perform Kegel exercises to help relax the pelvic floor muscles. The interface between your child’s muscles and the computer will be captured on the screen. Your child will learn through visual prompts how to relax his pelvic floor muscles during biofeedback. Once he masters this technique, you child can use it to relax with voiding.
Biofeedback is effective in helping children learn to empty their bladder completely — reducing urgency, wetting, and recurrent urinary tract infections.
- Behavior modification - Our psychologists work with you and your child to provide education about how the body works and why children need to follow the recommended treatment. We are the only pediatric urology program in the nation with psychologists embedded in our clinic who are dedicated to helping children with daytime and nighttime wetting.
Dysfunctional voiding is not usually caused by emotional factors, but it can take an emotional toll on the child and the family. 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. The psychologist assists families in finding ways to integrate the treatment plan into their daily lives for a successful outcome.
Many children we treat 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. They also can facilitate referrals to outside mental health professionals to help your child work on learning issues, emotional, or behavioral issues, if applicable.
- Medication - We use medications most frequently to treat frequent urinary tract infections in children with overactive bladder and in children with nighttime wetting.
Make an appointment
Our staff will help you schedule an outpatient appointment 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 Princeton. Contact us at 215-590-2754 to make an appointment at any of our locations.