Voiding Dysfunction

About Voiding Dysfunction

Enuresis (involuntary peeing that is abnormal for a child’s age) is one of the most common types of voiding dysfunction, and includes both nighttime wetting (nocturnal enuresis) and daytime wetting (diurnal enuresis).

Children often exhibit posturing behaviors, (pee-pee dance, cross their legs, squat). Although it is normal for very young children to do this as they are learning to toilet train, sometimes these symptoms can continue even as the child grows older.

Voiding dysfunction may cause a child to run to the bathroom frequently. Children may have to urinate every 10-30 minutes or in less severe cases, every 1-3 hours. They will often urinate small volumes or feel the urge to urinate again soon after voiding.

 
What causes voiding dysfunction?

The bladder is a muscle that stores urine, and it empties by contracting the muscle. A normally functioning bladder only contracts when it is at full capacity (the normal amount of urine that it can hold comfortably) and it is time to void.

When the bladder is irritable or overactive, it tends to contract at will, regardless of how much urine it is holding. It’s important for you to know that what your child is feeling is real and they do not have conscious control over it.

Constipation often contributes to these symptoms of voiding dysfunction. Your child may have mild to moderate constipation without complaining and the rectum and colon can stretch to accommodate the stool. This causes pushing on the bladder resulting in urgency/frequency, a decrease in capacity, and incomplete emptying.

 
How is voiding dysfunction diagnosed and treated?
In diagnosing overactive bladder, your Nemours pediatric urology team will do few things to rule out infection, or any serious, but rare, disorder:
  • thorough health history
  • physical exam
  • urinalysis and urine culture
  • renal and bladder ultrasound to check for bladder and kidney abnormalities
  • urine flow study (which uses a special toilet to measure your child’s voiding pattern)
  • post void residual (similar to the ultrasound, this is done after voiding to make sure your child is able to empty his or her bladder completely)

We will also ask you to keep a Voiding/Bowel Diary (PDF). This diary provides invaluable information that helps our Nemours pediatric urologists assess your child’s exact voiding problem. It will tell us how frequently your child is voiding, how much their bladder is letting them hold, if there is wetting and when this wetting occurs in relation to voiding. It will also allow us to better assess their stooling pattern and assure there is no constipation.

Most children will outgrow the symptoms of overactive bladder on their own without intervention, if there is no abnormality present. Your Nemours urologist may recommend some medications to relax the bladder depending on your preference and the age of your child.

Addressing your child’s symptoms of overactive bladder and wetting can dramatically improve your child’s quality of life. We often see children’s nighttime bedwetting improve after their daytime symptoms are addressed.

Bedwetting

Bedwetting is an issue that millions of families face every night. It is extremely common among young kids but can last into the teen years.

Doctors don't know for sure what causes bedwetting or why it stops. But it is often a natural part of development, and kids usually grow out of it. Most of the time bedwetting is not a sign of any deeper medical or emotional issues.

All the same, bedwetting can be very stressful for families. Kids can feel embarrassed and guilty about wetting the bed and anxious about spending the night at a friend's house or at camp. Parents often feel helpless to stop it.

Bedwetting may last for a while, but providing emotional support and reassurance can help your child feel better until it stops.

How Common Is Bedwetting?

Nocturnal enuresis, the medical name for bedwetting, is a common problem in kids, especially children under the 6 years old. About 13% of 6-year-olds wet the bed, while about 5% of 10-year-olds do.

Bedwetting often runs in families: many kids who wet the bed have a relative who did, too. If both parents wet the bed when they were young, it's very likely that their child will.

Coping With Bedwetting

Bedwetting usually goes away on its own. But until it does, it can be embarrassing and uncomfortable for your child. So it's important to provide support and positive reinforcement during this process.

Reassure your child that bedwetting is a normal part of growing up and that it's not going to last forever. It may comfort your child to hear about other family members who also struggled with it when they were young.

Remind your child to go to the bathroom one final time before bedtime. Try to have your child drink more fluids during the daytime hours and less at night. Avoid caffeine-containing drinks. Many parents find that using a motivational system, such as stickers for dry nights with a small reward (such as a book) after a certain number of stickers, can work well. Bedwetting alarms also can be helpful.

When your child wakes with wet sheets, don't yell or punish him or her. Have your child help you change the sheets. Explain that this isn't punishment, but it is a part of the process. It may even help your child feel better knowing that he or she helped out. Offer praise when your child has a dry night.

When to Call the Doctor

Bedwetting that begins abruptly or is accompanied by other symptoms can be a sign of another medical condition, so talk with your doctor.

The doctor may check for signs of a urinary tract infection (UTI), constipation, bladder problems, diabetes, or severe stress.

Call the doctor if your child:

  • suddenly starts wetting the bed after being consistently dry for at least 6 months
  • begins to wet his or her pants during the day
  • snores at night
  • complains of a burning sensation or pain when urinating
  • has to urinate frequently
  • is drinking or eating much more than usual
  • has swelling of the feet or ankles
  • your child is still wetting the bed at age 7 years

Also let the doctor know if your child is experiencing a lot of stress, if you're feeling frustrated with the situation, or could use some help. In the meantime, your support and patience can go a long way in helping your child feel better about the bedwetting.

Remember, the long-term outlook is excellent and in almost all cases dry days are just ahead.

Reviewed by: Mary L. Gavin, MD
Date reviewed: January 2012