Wetting accidents, frequent urinary tract infections or constipation can be upsetting for you and your child. We are here for you. At the Dysfunctional Outpatient Voiding Education (DOVE) Center at Children's Hospital of Philadelphia, we will sort out what is causing these problems and develop a plan to help correct them.

The DOVE Center is one of the largest and most comprehensive clinics in the United States devoted to children with bladder and lower urinary tract dysfunction. Our team includes urologists, nurse practitioners, physician assistants, nurses, physical therapists and psychologists.

At your child's first visit with us, a physician or an advanced practice provider (nurse practitioner or physician assistant) will ask about your child's health history and other medical conditions. Please bring a record of your child’s recent bathroom habits if possible. We will want to know how often your child goes to the bathroom, how often they have wetting accidents, if there are any bowel concerns, and whether there is a history of urinary tract infections. We will also conduct a physical examination of the abdomen, spine, and genitals.

After talking with you and your child, we might suggest doing some tests to make sure of the diagnosis and create a plan for treatment. The tests your child may undergo include:

• Uroflow: This is a simple and noninvasive test used to measure the flow of urine (pee). During the test, your child will pee into a special device that measures the speed and amount of urine. This test tells us how well the bladder is working, and it can help detect problems with urination, such as difficulty emptying the bladder or slow urination.
• Post-void bladder scan: This takes place in the office after urination to check for leftover urine in the bladder.
• Kidney, ureter, and bladder X-ray: This X-ray of the abdomen can tell us if your child is constipated. Incontinence (the loss of control over pee that leads to leakage of urine) and constipation (difficulty or pain during bowel movements) often happen together. Treating constipation can lead to a big improvement in wetting.
• Ultrasound: This assesses the size and shape of the kidneys and checks for bladder abnormalities
• Video urodynamic study (VUDS): This is a test that helps us understand how the bladder works. During the test, pictures and videos are taken of the bladder as it fills up and empties. This helps us see if the bladder is working properly. This test helps us understand why your child might have wetting accidents, trouble peeing or frequent trips to the bathroom. It can also help us decide on the best treatment.

Based on the results of your child's evaluation, our DOVE Center team may then suggest a variety of treatment approaches, including:

• Changing voiding/stooling habits: We often recommend stool softeners to help optimize bowel function and treat any underlying constipation. We will work with you to develop a schedule for your child that incorporates regular voiding and stooling throughout the day.
• Increasing fluid intake: We will tell your child about the importance of drinking water throughout the day and suggest how much they should drink regularly.
• Biofeedback training: We may help your child learn to relax their pelvic floor muscles to empty their bladder completely. This can reduce urgency, wetting and recurrent urinary tract infections. It involves using special techniques to show when the muscles are tensed and how to relax them.
• Behavior modification: Our psychologists will educate you and your child about how the body works and recommend behavioral strategies specific to your child’s strengths. We are one of the few pediatric urology programs in the country with psychologists in our clinic. They play a key role in helping children who have trouble with daytime and nighttime wetting.
• Medication: We may recommend medicine to help your child reduce and prevent urinary tract infections. We may also prescribe medication for children with overactive bladder and/or nighttime wetting.
• Neuromodulation: If your child still has symptoms despite behavior modification, medications and/or biofeedback, they may need a different way of resetting the brain-bladder connection. Neuromodulation involves stimulating nerves related to voiding using skin patches/stickers or a thin needle (like an acupuncture needle).