Once your child has been successfully potty-trained – ‘taking care of business’ should get easier – but what if the accidents keep happening?
When a child over the age of four has frequent daytime urinary accidents, and there doesn’t appear to be an underlying medical cause, he/she may be diagnosed with voiding dysfunction. Voiding dysfunction is very common, and can be used to describe problems with either holding urine in, difficulty emptying the bladder or urinary incontinence.
No one knows what causes voiding dysfunction, but the condition can impact children physically, socially and psychologically. Left untreated, some types of voiding dysfunction can cause permanent kidney damage over the long run. Luckily, there are several types of treatments that can help children successfully regain control of their bladder. Here are a few signs that your child may have voiding dysfunction:
Feels an urgent need to go without a full bladder. Children with overactive bladder (OAB) may sense the urge to use the bathroom every hour or more. Most children with OAB will have urinary incontinence and some may develop urinary tract infections (UTIs); sometimes these OAB symptoms will continue even in the absence of urinary infection. Some children may (unsuccessfully) try to “hold it” by crossing their legs or using other physical maneuvers. OAB is treated with behavioral therapy to retrain the bladder through scheduled potty times but sometimes also requires medications that reduce the urge to urinate.
Feels like the bladder is still full, even after going to the bathroom. In children with dysfunctional voiding, the muscles that control the flow of urine out of the body don’t relax completely, and the bladder never fully empties. This causes a range of symptoms such wetting during the day and night, a feeling that the bladder is always full, urgency, and straining to urinate. Children with this condition are at a higher risk for getting kidney infections. Dysfunctional voiding is treated with medicine to relax the bladder and behavioral therapy to retrain the brain and bladder to work together.
Urinates less than 3 times a day. Children with an underactive bladder are able to go for more than 6-8 hours without urinating. These children sometimes have to strain to urinate because the bladder muscle itself can become “weak” from being overstretched and may not respond to the brain’s signal that it is time to go. Accidental wetting with underactive bladder is caused by when the bladder becomes too full and overflows. These children are started on a timed voiding schedule such they try to go to use the restroom every few hours regardless of their perceived urge to urinate. This more frequent voiding schedule can help the bladder from becoming overstretched and restore the muscle tone.
Frequent constipation with daytime urinary incontinence. Studies indicate that almost ALL children with voiding dysfunction also have some element of constipation/fecal retention or bowel dysfunction. A major element of treating voiding dysfunction is aggressive therapy for relieving fecal retention. In many cases when the constipation is treated appropriately, the children’s bladder symptoms will improve or go away.
Bedwetting at night and having other bowel accidents. Bedwetting at night is very common in children even after successful toilet-training during the day. Most children who only wet the bed but have no daytime issues will not have abnormal urinary tract anatomy. However, children who wet the bed and also have bowel accidents (also known as encopresis) may have functional issues with the nerve signals to their bladder and/or bowels. When the signals to the bladder are disrupted, the same nerves that control bowel continence may also be affected and children may have difficulty controlling their bowel movements.
Over the age of 4 and successfully potty-trained, but still having daytime accidents. Voiding dysfunction is not typically diagnosed until a child is older than 4 and continues to experience daytime accidents for at least 6 months after toilet training ends. As a first step, a urologist will exam your child to see if there are any medical or anatomic reasons that could be causing daytime wetting. If the examination doesn’t reveal any issues, the physician may order additional testing that look at how the bladder is functioning and evaluate for evidence of bowel dysfunction.
If you think your child has any of these bladder issues or symptoms, call the Nationwide Children’s Hospital Urology Clinic (614) 722-6630 for an appointment to arrange for further evaluation and treatment.
Seth Alpert, MD is an attending surgeon in the Section of Urology at Nationwide Children’s Hospital and Clinical Associate Professor of Urology at The Ohio State University Medical Center.
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