Overactive bladder: paediatric aspects

Dr Nijman said that lower urinary tract function, which he called 'control', is a complex process of nervous system development and behavioural modification; indeed it is. This complexity is part of the price humans pay for their phylogenetic position. compared with, for example. freshwater coelenterates, which have only a single stoma for entry and exit of nutrients. Higher evolutionary life-forms, of necessity, evolved more sophisticated systems to manage elimination functions. For mammals, elimination is more than species-specific; in humans, various stages of life. lifestyles and transient situations place special demands on their excretory function. In fact. the fetus and infant control their lower urinary tracts very effectively, just as they control their pulmonary, cardiovascular and gastrointestinal systems. The difficulties lie in the assumption of conscious control over a previously neuro-viscerally controlled system, because of the effects of the elements of consciousness, behaviour, personality and social pressures. Most people manage these hurdles effectively. but it should come as no surprise that many children have some difficulty attaining cognitive management of the lower urinary tract. Most children surmount their problems, but for a few children the problems we label as dysfunctions become a way of life. There is probably one fairly simple unifying pathophysiological explanation for these dysfunctions.