Disfunção vesical e intestinal em crianças e adolescentes

Vera Q. Machado, Eliane Maria G. O. da Fonseca

Resumo


A presente revisão tem por objetivo apresentar e discutir as particularidades da disfunção vesical e intestinal (DVI) na infância. A associação de constipação intestinal com a disfunção do trato urinário inferior foi descrita inicialmente em 1998. Ambas são condições de alta prevalência na população pediátrica. A origem embrionária comum do reto e da bexiga na cloaca, sua inervação simpática (L1-L3) e parassimpática (S2-S4) similares, a representação afim em regiões supra espinhais, a proximidade anatômica, são diferentes teorias propostas para explicar essa associação. A melhora dos sintomas urinários está relacionada ao sucesso terapêutico para a constipação. Entretanto, muitas crianças com DVI apresentam constipação refratária ou respondem inicialmente ao tratamento, mas quando este é descontinuado, apresentam recidivas tanto dos sintomas de constipação, quanto dos sintomas do trato urinário inferior. Embora, história clínica e exame físico completos, associados ao diário das eliminações, sejam os pilares do diagnóstico da DVI, nos casos refratários, testes diagnósticos adicionais são necessários. O manejo terapêutico da DVI envolve: educação e desmistificação, adequação de hábitos intestinal e miccional e acompanhamento regular e prolongado. A dificuldade na abordagem terapêutica de crianças com DVI ainda é pouco explorada na literatura. A cronicidade dos sintomas intestinais e urinários interfere de forma significativa no desenvolvimento emocional desses pacientes. Estudos atuais chamam a atenção para a possibilidade da existência de uma desordem neuromuscular comum, responsável tanto pela dismotilidade vesical, quanto pela colônica. Esses achados poderão servir de base para o desenvolvimento de novas modalidades terapêuticas envolvendo ambos os sistemas.

Descritores: Disfunção vesical; Disfunção  intestinal; Constipação crônica; Disfunção do trato urinário inferior.


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