The prevalence of incontinence in children has been extensively studied, but knowledge of other bladder symptoms is lacking in a healthy child population. The micturition habits of 3556 7-year-old school entrants were surveyed by a questionnaire supplemented by telephone interviews. One or more symptoms of a disturbed bladder function was reported in 26%, but most of these had moderate urgency as a sign of incomplete voluntary bladder control. Isolated bedwetting occurred in 2.8% of the girls and 7.0% of the boys, whereas nocturnal incontinence combined with daytime wetting was equally common in both sexes, 2.3% and 2.0% respectively. Diurnal incontinence was reported in 6.0% of the girls and 3.8% of the boys and was usually combined with other symptoms. The frequency of micturition in children without symptoms of bladder disturbance and with no previous urinary tract infection was 3-7 times per day.

The association between current micturition habits and previous urinary tract infection was analysed among 3553 school entrants aged 7 years by means of a questionnaire. A high incidence of urinary infection, confirmed by urine culture, was found (145 (8-4%) in the 1719 girls and 32 (1-7%) in the 1834 boys). There was a significant association between current symptoms that were suggestive of disturbed bladder function and previous urinary tract infection, but only among girls who were over 3 years of age at the time the first episode was diagnosed. Another important abnormality in children with recurrent urinary infections is poor coordination between the detrusor and the sphincter.4 Before the amount of residual urine is measured or urodynamic investigations are started, however, the symptoms of the child should be analysed. The most obvious symptom of bladder dysfunction is incontinence, which is associated with urinary infection.5 6 The incidence of other symptoms suggestive of bladder dysfunction is, however, not known. We therefore studied the association between current symptoms suggestive of bladder dysfunction and a history of previous urinary infections in an unselected group of 7 year old school entrants.Subjects and methods All Swedish children attend a health examination together with a parent and the teacher on entering school at the age of 7. Different problems are discussed with the school physician and the school nurse. Before this examination a health questionnaire is given to the families, to use as a basis for discussion. In 1982 an additional questionnaire about current micturition habits and urinary incontinence was given to all Swedish speaking school entrants in Goteborg by the school nurses.7 Previous urinary infections and other diseases of the urinary tract were also investigated. If there was anything abnormal or unanswered in the questionnaire the family was contacted by telephone for more details by one of the investigators. Children with problems were offered further examination at the children's hospital.Nocturnal as well as diurnal incontinence was defined as wetting at least once during a three month period. Urgency was defined as a short latent period between the first sensation and the need to void that occurred daily. Children who were able to postpone micturition voluntarily while they were occupied were not considered to have urgency. A specific question was asked about the use of a squatting position to prevent incontinence (the 'curtsy' sign8) and whether this was used at least once a week. A child was considered to have emptying difficulties when symptoms such as starting difficulties, poor or interrupted stream, straining or manual compression of the bladder, or prolonged micturition occurred more than twice a week.The original records from hospitals and outpatient clinics of children who gave a history of urinary infections or other diseases of the urinary tract were studied, and the diagnosis of urinary tract infection re-evaluated. The growth of at least 105 ...

During the first 3 years of life the number of voiding episodes, including interrupted voiding, post-void residual urine and voiding during sleep, decreased while bladder capacity increased.

The 4-hour voiding observation is an easy noninvasive method of characterizing the voiding pattern, focusing especially on emptying difficulties, in infants and nontoilet trained children.

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At age 17 years, micturition disturbances were reported infrequently and few subjects wanted medical help.

We suggest that previously described urodynamic patterns of the valve bladder (unstable, poorly compliant and over distended bladders) are variations of the same basic pattern that changes with time toward decompensation.

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