Overactive Bladder in Children

Medically Reviewed by Minesh Khatri, MD on May 27, 2023
5 min read

Overactive bladder can cause urinary incontinence, which is the involuntary release of urine. Children as well as adults can have an overactive bladder. Although each child is unique, most children are able to stay dry during the day by the age of 4 and through the night by 5 or 6.

A child with an overactive bladder will need to urinate frequently and, at times, the need may be urgent. They may not make it to the toilet before the urine begins to flow.

Children with overactive bladders have a need to urinate more often than usual because their bladder muscles have uncontrollable spasms. The muscles surrounding the urethra -- the tube from the bladder that urine passes through -- can be affected. These muscles are meant to prevent urine from leaving the body, but they may be "overridden" if the bladder undergoes a strong contraction.

Urinary tract infections can cause a need to urinate as the urinary tract becomes inflamed and uncomfortable. Certain neurological conditions may cause these symptoms.

Another cause of overactive bladder is a condition called pollakiuria, or frequent daytime urination syndrome. Children who have pollakiuria urinate frequently. In some cases, they may urinate every five to 10 minutes or urinate between 10 and 30 times a day. This condition is most common among children aged 3 to 8 and is present only during waking hours. There are no other symptoms present. Doctors believe that pollakiuria is related to stress. Usually, the condition goes away after two to three weeks without requiring treatment.

Other causes of overactive bladder in children include:

  • consumption of caffeine, which increases urine output and can cause spasms in the bladder muscle
  • consumption of ingredients that a child may be allergic to
  • events that cause anxiety
  • infrequent urination (holding urine for too long a period of time)
  • small bladder capacity
  • structural abnormalities in the bladder or urethra
  • constipation
  • refraining from completely emptying the bladder when on the toilet
  • obstructive sleep apnea

In most cases, children outgrow the problem of an overactive bladder. For each year after the age of 5, the number of overactive bladder cases declines by 15%. The child may learn to respond in a more timely manner to the body's signals to urinate or bladder capacity may increase over time. In addition, overactive bladders can "settle down," often when stressful events or experiences have ended.

If the child does not outgrow the condition, treatments can include bladder training and medication. In bladder training, the child uses exercises to strengthen and coordinate the urethra and bladder muscles to control urination. Such exercises teach the child to prevent urinating when away from the toilet and to anticipate the urge to urinate. Additional techniques to help overactive bladder include:

  • avoiding caffeine or other ingredients that may encourage overactive bladder
  • using timed voiding, or urinating on a schedule -- for example, every two hours
  • adopting healthy urination habits, such as taking enough time to urinate and relaxing muscles during urination

The medication oxybutynin is used to control such problems as urgent, uncontrolled, or frequent urination and other conditions that affect the bladder muscles. Oxybutynin works by relaxing the bladder muscles to prevent urinary problems. However, there are newer drugs available that may have fewer side effects.

If overactive bladder is caused by a urinary tract infection, your child's doctor may prescribe antibiotics to clear up the infection.

Yes. Some of the same conditions or circumstances that increase the likelihood of nighttime incontinence may -- in combination with infrequent urination -- result in incontinence during the day. These conditions and circumstances include pressure from a hard bowel movement or other causes listed above.

Another cause of nighttime incontinence is related to the antidiuretic hormone (ADH), which the body produces to slow urine production. Children tend to produce more ADH at night, so there is less need to urinate. If the body does not produce enough ADH, the production of urine may not slow and the bladder may overfill, leading to bedwetting.

Some other potential causes of bedwetting include:

  • Family history
  • Stress and life changes like a new sibling, changes in living circumstances
  • Sleep disruptions
  • Type 1 diabetes- also causes increased thirst and urination

In the vast majority of children, bedwetting improves on its own over time, so treatment is not needed. If bedwetting is a significant problem for a child, there are several ways to approach bedwetting .

Cut back on their liquid intake well before bedtime, particularly anything that includes caffeine. Encourage your child to not only use the bathroom 15 minutes before bed, but again just before you tuck them in. Oftentimes, they pee only enough so they no longer feel the urge and may not be emptying their bladder. Remove any sleep disrupters from their room, like pets or electronics.

Another treatment for bedwetting is a moisture alarm. This device includes a water-sensitive pad with a wire connected to a control unit. When moisture is detected, an alarm sounds, waking the child. In some cases, another person may need to be in the room to awaken the child if they do not do so on their own.

Setting an alarm so the child wakes up to urinate - timed voiding - may also work to reduce bedwetting at night.

If these methods aren't working, medication Increasing levels of ADH might help treat nighttime incontinence. Desmopressin, or DDAVP, is a synthetic version of ADH. This drug, which is approved for use in children, comes in pills, nose drops, or nasal spray.

In addition, the drug imipramine can be used. This medication affects the brain as well as the bladder. According to researchers, an estimated 70% of kids who wet the bed may be helped by the use of these drugs.

If there is an accident, don’t scold or punish them, because this can add stress and shame which may result in more accidents or even attempts to hide their bedwetting.

Keep track of the victories and reward them. It will also help you see what is working and identify any patterns.