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Understanding paediatric bladder dysfunction: a guide for parents and caregivers

Understanding bladder health in children is crucial, as it not only affects their physical wellbeing but also impacts their confidence and social development. Early recognition and management of bladder problems can prevent complications, enhance quality of life and support a child’s growth and development in crucial years.


Woman and child in bathroom

It is imperative, therefore, that parents are equipped with the right information to identify and address bladder health issues promptly. This guide is designed to help you understand the signs, causes and treatments of paediatric bladder dysfunction, ensuring your child receives the best possible care. 


The bladder is a crucial component of the body's urinary system, functioning primarily as a storage unit for urine. It is a muscular sac situated in the pelvis, just above and behind the pubic bone. When functioning normally, the bladder fills gradually with urine that is produced by the kidneys, stretching to accommodate the increasing volume. This urine is then expelled from the body during the process of urination.


In children, bladder control is a developmental skill that matures over time. In infancy, children do not have voluntary control over their bladder emptying; it happens reflexively. As a child grows, the nervous system develops, enabling them to start recognising the sensation of a full bladder. By the age of about two to three years, most children begin to show signs of bladder control, such as indicating they need to urinate. Full control and the ability to reliably hold urine and void at appropriate times generally develop by the age of five or six. However, it's important to note that like all developmental milestones, the age at which complete bladder control is achieved can vary widely among children.


Understanding this natural progression helps in recognising and managing deviations that might indicate underlying issues or delays in bladder function development.


What is a healthy bladder?


A healthy bladder in children functions efficiently in storing and expelling urine, playing a vital role in overall health and wellbeing. The primary characteristics of normal bladder function in children include the ability to hold urine for several hours, painless urination and the complete emptying of the bladder during each toilet visit.


In terms of frequency, the number of times a child should urinate each day can vary depending on their fluid intake and individual body needs. Typically, it is normal for a child to urinate anywhere from four to seven times a day. Children who are toilet trained and older should be able to sleep through the night without the need to urinate or wake up to go to the toilet.

Consistency in these patterns without discomfort suggests that the bladder is functioning healthily. Conversely, any significant deviation from these habits, such as frequent urination, urgency, pain during urination or nocturnal enuresis (bedwetting) past the age of five to six years, might signal a need for medical evaluation.


Healthy urine colour


The colour of urine can be a significant indicator of a child's hydration status and overall health. Typically, healthy urine colour ranges from pale straw to a deeper yellow. This variation is primarily influenced by the level of hydration; well-hydrated children typically have lighter-coloured urine.


  • Pale straw to light yellow: This is the ideal urine colour, indicating that your child is well-hydrated. It suggests a healthy balance of water and waste products being expelled by the kidneys.

  • Dark yellow: While still within the normal range, dark yellow urine might suggest that your child needs to increase their fluid intake, especially water, to avoid dehydration.

  • Amber or honey: This darker shade is a warning sign that your child is not drinking enough fluids. It is advisable to encourage them to drink more water throughout the day.


Parents should monitor not only the frequency but also the appearance of their child's urine. Any persistent colour changes, especially those accompanied by other symptoms like pain or discomfort, should prompt a visit to a healthcare professional to rule out any underlying issues.


Hydration and its importance 


Proper hydration is crucial for maintaining good health in children, influencing not only the bladder's function but also their overall wellbeing. Water helps to flush out toxins and waste products from the body, aiding in digestion and keeping the urinary tract clean, which in turn reduces the risk of urinary tract infections (UTIs).


How much should children drink per day? 


The amount of fluid a child needs can vary based on their age, size, the level of their physical activity and even the climate they live in. However, as a general guideline:


  • Younger children (ages 4-8 years): 1.1-1.3 litres (boys and girls)

  • Older children (ages 9-13 years): 1.3-1.5 (girls), 1.5-1.7 litres (boys)

  • Teenagers (ages 14+ years): 1.4-1.6 (females), 1.74-2 litres


The figures above are for drinks only – children should also take more fluid via their food each day.  It's important to note that children should increase their fluid intake in hot weather or during physical activity to compensate for increased fluid loss through sweat.


The role of hydration in bladder health and beyond


Hydration plays a pivotal role in bladder health by ensuring that urine is diluted and less likely to irritate the bladder lining. This is particularly important in preventing UTIs, which are more common when children do not drink enough fluids to help flush bacteria from the urinary tract.

Moreover, adequate hydration is essential for maintaining concentration levels in children. Dehydration can lead to decreased cognitive function, affecting a child’s ability to concentrate in school and during other activities. Ensuring that your child drinks enough water throughout the day is critical to support their concentration and overall cognitive function.


Encouraging good hydration habits from a young age can help instil behaviours that lead to a lifetime of healthy living. Simple practices like carrying a water bottle to school, drinking water before, during and after physical activity and choosing water over sugary drinks can make a significant difference in a child's hydration levels and overall health.


Common bladder problems in children 


Bladder issues in children can vary widely, with some being fleeting concerns, while others require medical intervention. Common symptoms that may indicate a bladder problem include urgency, frequency and incontinence. Understanding these symptoms can help parents discern when to seek help.


Symptoms


  • Urgency: This refers to a sudden, compelling need to urinate, which is difficult to defer. Children may feel this need abruptly and intensely, often leading to discomfort.

  • Frequency: This involves urinating more often than usual without an increase in total daily urine volume. Frequent trips to the bathroom during the day or having to wake up multiple times at night to urinate might indicate an issue.

  • Incontinence: This is the involuntary loss of urine, which can occur during the day (daytime incontinence) or at night (nocturnal enuresis). Incontinence may be experienced as occasional dribbles or more significant urine leaks.


Occasional vs. persistent bladder issues


Understanding the distinction between occasional and persistent bladder issues is crucial for effective management:


  • Occasional symptoms: These are often linked to specific situations such as an increase in fluid intake, excitement or stress. They may resolve on their own without medical intervention. For example, a child may exhibit urgency or frequency when they consume large amounts of fluid or are in a new environment.

  • Persistent symptoms: These are more concerning as they recur regularly and can disrupt a child’s daily life. Persistent symptoms might indicate underlying conditions such as urinary tract infections, bladder irritability or other functional disorders. Persistent incontinence, especially if it continues past the typical toilet training age, warrants a consultation with a healthcare provider.


Parents should monitor their children’s symptoms and behaviours. Occasional symptoms are generally not a cause for concern unless they become more frequent or are accompanied by pain, discomfort or behavioural changes. On the other hand, persistent symptoms require assessment by a professional to diagnose any underlying conditions and commence appropriate treatment. This proactive approach ensures any serious issues are addressed promptly, fostering better health and comfort for the child. 



Causes of children's incontinence


Incontinence in children can be a distressing symptom for both the child and their family. Understanding the underlying causes, which can be medical or behavioural, is crucial for effective management and treatment. 


Medical causes


  1. Urinary tract infections (UTIs): These infections can irritate the bladder, causing urgent, frequent and painful urination. Children may not always communicate their discomfort clearly, which can sometimes result in unnoticed and untreated infections leading to incontinence.

  2. Constipation: Often overlooked, constipation can significantly affect bladder control. The rectum is located near the bladder and shares many of the same nerves; when the rectum is full, it can put pressure on the bladder, leading to incontinence.

  3. Structural problems: Abnormalities in the urinary tract structure or nervous system can affect how well a child can control urination. Conditions such as spina bifida or congenital defects in the urinary tract structure are examples.

  4. Neurological disorders: Any disorder that impairs nerve function can interfere with bladder control. This includes conditions like cerebral palsy or other neurological impairments.


Behavioural causes


  1. Delayed or inconsistent toilet training: Children who start toilet training significantly later than usual, or whose toilet training was inconsistent or interrupted, may struggle with incontinence.

  2. Overactive bladder: This condition involves a sudden involuntary contraction of the muscle in the wall of the bladder, causing an urgent need to urinate even when the bladder may not be full.

  3. Emotional stress: Psychological factors such as anxiety, stress or significant life changes (like starting school or family upheaval) can manifest physically in children through symptoms like incontinence.

  4. Habitual retention: Some children habitually delay going to the toilet when they are busy playing or engaged in activities they enjoy, leading to occasional incontinence.


Interplay of causes


Often, it’s not just one factor but a combination that leads to incontinence. For instance, a child with occasional constipation may experience more frequent episodes of incontinence during times of emotional stress. Understanding these interrelated causes is crucial in developing a comprehensive approach to treatment.


By identifying the specific causes of a child’s incontinence, you can tailor an appropriate treatment plan that addresses both the symptoms and the underlying issues, thus enhancing the child's quality of life and reducing the stress associated with incontinence.


Treating incontinence in children


Treating incontinence in children effectively requires a combination of medical interventions, behavioural adjustments and supportive home strategies. Addressing both the symptoms and the underlying causes can significantly improve outcomes and enhance the child's comfort and confidence.


Medical treatment options


  1. Medication: Depending on the cause, doctors may prescribe medications to manage symptoms. For instance, anticholinergics can help relax an overactive bladder, while antibiotics are used to treat urinary tract infections.

  2. Biofeedback: This technique involves using monitoring devices that help children become aware of their body's functions. Biofeedback can be particularly effective for children who need to learn to control certain muscles of the urinary tract.

  3. Surgery: Although rare, surgery might be necessary for children with anatomical abnormalities that contribute to incontinence.


Behavioural treatment options


  1. Bladder training: This involves teaching the child to follow a schedule for using the toilet, gradually increasing the intervals between toilet visits to train the bladder to hold urine for longer periods.

  2. Pelvic floor exercises: Strengthening the muscles of the pelvic floor can help control urination. These exercises are often recommended for older children who can follow specific instructions to engage the correct muscles.


Home strategies to support treatment


  1. Fluid management: Encourage regular fluid intake throughout the day but reduce fluids before bedtime. This helps manage the balance between adequate hydration and reducing the likelihood of bedwetting.

  2. Diet adjustments: Ensure the child's diet includes foods that promote good digestion and avoid those that might irritate the bladder, such as caffeine and overly acidic foods.

  3. Encourage regular toilet use: Remind your child to use the bathroom at regular intervals (every 2-3 hours) and ensure they do not rush the process. Taking enough time to fully empty their bladder can reduce the frequency of accidents.

  4. Positive reinforcement: Use encouragement and positive reinforcement to build your child’s confidence in managing their condition, avoiding any negative responses to accidents which can lead to anxiety and exacerbate the issue.

  5. Stress management: Since emotional stress can impact bladder control, providing a supportive environment and considering counselling if needed can be beneficial.


Combining these medical and behavioural approaches with supportive home strategies creates a comprehensive treatment plan that addresses the various aspects of incontinence. This approach not only helps manage the symptoms but also supports the child’s overall development and well-being.


Recognising and managing overactive bladder


An overactive bladder in children can cause significant distress and disruption to daily life. Understanding how to identify and manage this condition is key to helping your child lead a more comfortable and confident life.


How to spot symptoms of an overactive bladder 


The primary symptom of an overactive bladder is a sudden, intense urge to urinate that is difficult to control. This may result in the frequent need to use the bathroom and potentially lead to episodes of incontinence. Children with this condition might:


  • Urinate more than eight times a day.

  • Need to urinate multiple times during the night.

  • Experience occasional leakage when they cannot reach the toilet in time.


These symptoms can interfere with daily activities and significantly impact a child's emotional wellbeing and social life.


Main causes of overactive bladder in children


Several factors can contribute to the development of an overactive bladder in children:


  • Neurological disorders: Conditions affecting the nervous system can disrupt normal bladder function.

  • UTIs: These can irritate the bladder, increasing the frequency and urgency of urination.

  • Constipation: The pressure from a full bowel can adversely affect the bladder’s ability to function correctly.

  • Family history: Genetics may play a role in predisposing a child to bladder health issues, including overactive bladder.


Can an overactive bladder be cured? 


Yes; the prognosis for an overactive bladder in children is generally positive, with many experiencing significant improvement through treatment. It won’t ‘go away’ on its own; the condition should be effectively managed and sometimes completely resolved with the right approach. 


With appropriate intervention, most children can gain better control over their bladder function, significantly reducing the impact of the condition on their daily lives. Early recognition and treatment are crucial in achieving the best outcomes, and continuous support from family, healthcare providers and sometimes therapists can provide the foundation for effective management.


Children's UTI symptoms and treatments


UTIs are common in children and can cause significant discomfort and potential health complications if not treated promptly. Recognising the symptoms and understanding the treatment options are crucial steps in managing UTIs effectively.


Children with UTIs may not always be able to articulate their discomfort clearly, making it imperative for parents and caregivers to be vigilant about recognising the signs. Symptoms of a UTI in children can include:


  • Pain or burning sensation during urination: This is one of the most common signs of a UTI.

  • Frequent urination: An increased urge to urinate, often with very little urine being passed.

  • Urgency: Needing to urinate suddenly and urgently.

  • Fever: Especially without other signs of common illnesses like coughing or a runny nose.

  • Abdominal pain: Pain, discomfort, or pressure in the lower abdomen.

  • Changes in urine appearance: Cloudy, dark, bloody or strong-smelling urine.

  • Incontinence: New or increased episodes of wetting in a toilet-trained child.

  • Lethargy or irritability: Particularly in younger children who cannot explain how they feel.


Effective treatments for UTIs


  • Antibiotics: These are the primary treatment for UTIs. The type, dose and duration of antibiotics may vary based on the child's age, the severity of the infection and the specific bacteria causing the infection.

  • Pain relief: While antibiotics address the infection, pain relief medication can be used to ease discomfort.

  • Increased fluid intake: Encouraging the child to drink plenty of fluids helps flush out bacteria from the urinary system.


It is crucial to complete the full course of prescribed antibiotics even if symptoms improve, to ensure the infection is fully eradicated and to prevent resistance.


Preventive measures


Preventing UTIs involves several straightforward but effective strategies:


  • Encourage regular urination: Children should be encouraged to urinate frequently to prevent urine from staying in the bladder too long.

  • Promote good hygiene: Teach children proper wiping techniques (from front to back) to prevent bacteria from the bowel entering the urinary tract.

  • Adequate hydration: Ensuring your child drinks plenty of fluids throughout the day helps dilute the urine and ensures regular flushing of the urinary tract.

  • Avoid constipation: A diet high in fibre can prevent constipation, reducing the risk of UTI, as a full bowel can put pressure on the bladder.


By understanding the symptoms and treatments of UTIs and implementing preventive measures, parents can help safeguard their children from this uncomfortable and potentially serious infection.


Monitoring your child’s bladder health is an essential aspect of their overall well-being. By staying vigilant and observant of the signs of potential bladder issues, you can ensure prompt and effective treatment that could prevent further complications and promote healthy development.


Should you notice any irregularities or if you have concerns about your child's bladder health or urinary habits, do not hesitate to seek professional advice. Early intervention is key to effectively managing and resolving many paediatric bladder conditions. PeePS is dedicated to supporting you and your child through any bladder health concerns – take advantage of a FREE 15-minute discovery call, it is your opportunity to discuss your concerns, ask questions and find out how we can help your child achieve optimal bladder health.


Do not let bladder issues diminish your child's quality of life. Contact PeePS today to schedule your free discovery call and take the first step towards effective management and peace of mind. 


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