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Overactive Bladder in Children: Causes, Diagnosis, and Treatment

Overactive bladder

Overactive bladder (OAB), a specific type of urinary incontinence, is a common childhood condition defined by a sudden and uncontrollable urge to urinate. It can lead to accidents during the day. A parent may also ask a child if they need to go to the bathroom. Even though the child says no, they’ll have an urgent need to go minutes later. OAB is not the same as bed-wetting, or nocturnal enuresis. Bed-wetting is more common, particularly in young children.

Symptoms of OAB can interfere with a child’s day-to-day routines. It’s important to react to daytime accidents with patience and understanding. These incidences can often impact a child’s social and emotional development. Other physical complications of an OAB in children are:

  • difficulty emptying the bladder completely
  • an increased risk for kidney damage
  • an increased risk for urinary tract infections

Talk to your doctor if you suspect your child has an OAB. In most cases, an OAB goes away with time. If not, there are treatments and at-home measures available to help your child overcome or manage this condition.

At what age should children be able control their bladder?

children

Wetting in children under 3 years old is very common. Most children will be able to control their bladder after they turn 3, but this age can still vary. An OAB is often not diagnosed until a child is 5 or 6 years old. By the age of 5, more than 90 percent of children are able to control their urine during the day. Your doctor may not diagnose nighttime urinary incontinence until your child is 7 years old.

Bed-wetting affects 30 percent of 4-year-olds. This percentage decreases each year as children get older. About 10 percent of 7-year-olds, 3 percent of 12-year-olds, and 1 percent of 18-year--olds will still wet the bed at night.

Symptoms of OAB

Symptoms

The most common symptom of OAB in children is the urge to go to the bathroom more often than is normal. A normal bathroom habit is about four to five trips per day. With OAB, the bladder may contract and cause the sensation of needing to urinate, even when it isn’t full. Your child may not directly tell you that they have the urge. Look for signs like squirming in their seat, dancing around, or jumping from one foot to the other.

Other signs may include:

  • going to the bathroom but not being able to urinate
  • experiencing an urge to urinate, but not passing any urine
  • frequent urinary tract infections
  • accidents during the day

Less commonly, your child may experience leakage, especially when active or when sneezing.

Bed-wetting

Bed-wetting occurs when a child cannot control his or her urination at night. It’s a type of dysfunction that can accompany overactive bladder but is usually unrelated to it. This problem is considered abnormal when it occurs in children older than 5 to 7. If this condition is accompanied by constipation and fecal accidents, it’s called dysfunctional voiding.

What causes OAB in children?

Causes

There are several possible causes of OAB. Some causes vary based on a child’s age. For example, in children 4 to 5 years old, the cause may be:

  • change in routine, such as moving to a new city or having a new brother or sister in the house
  • forgetting to use the toilet because they are engaging in other activities
  • illness

Other causes in children of all ages can include:

  • anxiety
  • drinking caffeinated beverages or fizzy drinks
  • emotional upset
  • having problems with constipation
  • frequent urinary tract infections
  • nerve damage or malfunction that causes a child to have difficulty recognizing a full bladder
  • refraining from completely emptying the bladder when on the toilet
  • underlying sleep apnea

In some kids, it may be a delay in maturation and will eventually go away with age. But because bladder contractions are controlled by nerves, it’s possible that OAB may be caused by a neurological disorder.

A child may also learn to hold their urine, which can affect their ability to fully empty their bladder. The long-term effects of this habit can be urinary tract infections, increased urinary frequency, and kidney damage. See a doctor if you’re concerned that your child’s OAB hasn’t gone away on its own.

When to see a doctor

when to see a doctor

Make an appointment with your pediatrician for a check-up if your child has any signs of OAB. This is especially true if your child is 7 years old or older. Most children this age will have bladder control.

When you see the doctor, they’ll want to give your child a physical exam and hear a history of symptoms. Your doctor may also want to check for constipation and take a sample of urine to analyze for infection or other abnormalities.

Your child may also need to participate in voiding tests. These tests may include measuring the volume of urine and anything left in the bladder after voiding, or measuring the flow rate. In some cases, your doctor may want to do an ultrasound to determine if structural issues of the bladder may be the cause.

Treating OAB in children

Treatment

OAB usually goes away as a child gets older. As a child grows:

  • They can hold more in their bladder.
  • Their natural body alarms start to work.
  • Their OAB settles down.
  • Their body’s response improves.
  • Their body’s production of antidiuretic hormone, a chemical that slows the production of urine, stabilizes.

Bladder retraining

Your pediatrician will likely suggest nonmedical strategies like bladder retraining first. Bladder retraining means sticking to a urination schedule and resisting the urge to go in between. Your child will learn to gradually hold their urine longer to stretch their bladder. A sample urination schedule would be to go to the bathroom every two hours. Another option is called double voiding, which involves trying to urinate again after the first time to ensure the bladder is fully emptied.

Some children also respond to therapy known as biofeedback training. Led by a therapist, this training helps a child learn how to focus on the bladder muscles and relax them while urinating.

Medications

Your pediatrician will probably suggest medications if the nonmedical strategies fail to help your child. If your child is constipated, your doctor may prescribe a laxative. If your child has an infection, antibiotics may also help.

Medications for children help relax the bladder, which reduces the urge to go as frequently. An example is oxybutynin, which has side effects that include dry mouth and constipation. It’s important to discuss the potential side effects of these medications with a physician. It’s possible for the OAB to return after your child stops taking the medication.

At-home remedies

Home remedies you can do include:

  • Have your child avoid drinks and food with caffeine. Caffeine can stimulate the bladder.
  • Create a reward system so children have an incentive. It’s important not to punish a child for wetting accidents, but instead reward positive behaviors.
  • Serve bladder-friendly foods and drinks. These foods include pumpkin seeds, cranberry juice, diluted squash, and water.

Take care to observe when and why your child has daytime accidents. Reward systems can help with getting your child back on schedule. It can also help create positive associations for communication so that your child feels comfortable letting you know when they need to go.

Keep reading: 11 foods to avoid if you have OAB »

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