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
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.
The term neurogenic bladder refers to a bladder that doesn't function properly because of nervous system damage.
More to Know
Functions like filling, storing, and emptying the bladder are regulated by nerves. When these nerves become damaged, nerve signals are disrupted and loss of bladder control results.
Neurogenic bladder is often caused by an injury, tumor, or defect of the central nervous system (the brain and spinal cord). Diseases like cerebral palsy, multiple sclerosis, and neural tube defects like spina bifida also can be responsible. Sometimes nerve damage due to heavy, long-term alcohol use, diabetes, or a slipped disk will cause the problem.
Symptoms of neurogenic bladder may include frequent urination (peeing), inability to fully empty the bladder, incontinence (the accidental release of urine), and urinary retention (inability to urinate). People with the disorder are also more likely to develop urinary tract infections (UTIs).
Treatment for neurogenic bladder might include medication, strengthening exercises, or the use of a urinary catheter. Some people will need surgery to help ease symptoms.
Keep in Mind
Neurogenic bladder is not curable, but it is manageable. It's important to see a doctor as soon as the condition develops, however. Left untreated it can lead to kidney failure, which can be life threatening.
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