53 Conclusion Constipation doesn’t seem to be the case with Lisa because she doesn’t have symptoms according to Rome IV and her rectum is normal width on ultrasound. With a micturition that is below normal in frequency (as shown on the bladder dairy), small amount of urine incontinence, large amount of urine in the bladder and an interrupted stream with low Qmax on uroflow, a diagnosis of underactive bladder can be confirmed. Treatment phase Basic urotherapy Information and demystification Explain to Lisa the anatomy of the pelvis with the bladder, vagina, rectum, and pelvic floor. Use a drawing, pictures, or movies to show the normal physiology of the urinary tract. Explain briefly, the relation between the rectum and bowel function and the bladder. Go through the symptoms and problems for Lisa and how they could be explained in the body. Wee factory Talk with Lisa and her parent that it is very important that Lisa herself wants to get better and that it will take some work. Lisa is motivated and says that she finds her trouble very distressing and wants to get better. Lifestyle advice Lisa needs to adjust her toilets habits during the day. She needs to pee every 2-3 hours and drink 6-8 glasses of drinks, preferably water, spread out during the day. She needs to take her time on the toilet although there could be times that she doesn’t pee when she sits on the toilet. The bladder could be needing some training on starting a void with smaller amounts of urine than now.
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