Unstable bladder: This is a very frequent problem that can start anytime during childhood. The bladder is hyperactive and tries to empty frequently, often without warning. The child with this problem may run to the bathroom, have many accidents and try to hold him/herself to prevent leakage. They may feel the urge to go but may be unable to pass any urine. This problem may in some cases be related to urinary tract infections, constipation, stress at home or use of caffeine. In most cases, the problem improves with time although it can be treated by school age if wetting during the day is embarrassing to the child.
Uncoordinated voiding: In some cases, a child with an unstable bladder learns to hold onto urine and then cannot empty the bladder properly. This may lead to infections, more wetting and in severe cases, kidney damage. The child may also hold onto feces and be constipated with periodical soiling of underwear.
Frequency-urgency syndrome of childhood: Some children (mostly boys) develop a sudden problem with needing to go to the bathroom frequently, as often as every 10 minutes. These children were fine prior to developing this problem. They often are able to sleep through the entire night without going to the bathroom or wetting the bed, although they may have occasional bedwetting or wet underwear. The problem tends to go away on its own but may last for months or a year or longer.
Infrequent voiding: Some children are brought to our attention because they get urinary tract infections and the family notices that they go to the bathroom only 2 or 3 times a day. Holding the urine in for long periods can allow germs to get into the bladder and start an infection. Urination helps prevent infection by flushing out the bladder.
Unstable bladder: If your child is young and has no other problems with the urinary tract, we may see if the problem goes away on its own. It may help to avoid caffeine, to encourage your child not to delay urination and to treat constipation if present. If the problem persists, we may recommend treatment with medication. The most common drug used is ditropan. Ditropan helps reduce bladder contractions to allow the bladder to fill further without trying to empty. It is given 2 or 3 times a day. Side effects may include: red face, dry mouth, constipation, drowsiness, reduced sweating which may lead to severe overheating in the summer, blurred vision and personality changes. Most children tolerate ditropan without serious problems, but reducing the dose may help if side effects occur. Similar drugs are levsin and probanthine which may also have these side effects. If any problems occur with one of these medicines, you should stop it and contact our office. If effective, we usually continue the medicine for up to 6 months and then stop it and see how your child does without it.
Uncoordinated voiding: If your child has reflux or frequent infections, these will be treated (see our other phamplets). If your child does not empty his/her bladder we may recommend that he/she urinate twice in a row to more completely empty the bladder. In rare cases, we may ask you and your child to learn how to empty the bladder with a catheter on a routine basis (intermittent catheterization) for awhile. This usually needs to be done 4 or 5 times a day and we will give you specific instructions on how to do it.
Frequency-urgency syndrome: If your child has these symptoms and all our tests are normal, we usually recommend waiting until the problem stops on its own. In many cases, medicine is not effective for this problem.
Infrequent voiding: If your child has urinary tract infections and does not urinate frequently, we will recommend that he/she be encouraged to go to the bathroom more often. Since the bladder may be overstretched in people who do not empty it very often, your child may say that he/she does not have to go as often as necessary. Therefore, it is likely that you will have to encourage your child to go "by the clock" for awhile until he/she develops a habit of urinating more frequently (at least every 3-4 hours during the day.)