Understanding Your Child’s Toileting Behaviors: Overactive vs. Underactive Bladder
As a parent, it’s common to notice when your child is struggling with bathroom habits. This can look different for everyone – whether it’s frequent accidents, rushing to the toilet, or rarely going at all! While potty training challenges are common, persistent issues may point to an underlying bladder dysfunction that requires attention. Two of the most common bladder patterns seen in pediatric urology are overactive bladder and underactive bladder. Understanding the difference between the two plays a key role in getting the right treatment and support.
Overactive Bladder
What is it?
Overactive bladder occurs when the bladder muscles (called the detrusor muscle) contract too frequently or during inappropriate times (ex: when the bladder is not completely full). This can lead to a sudden, intense urge to urinate and lead to accidents if the child can’t reach the bathroom in time.
Common signs?
Frequent urination (ex: more than 8x per day)
Urgency – “I have to go RIGHT now”
Urge incontinence – leaking before reaching the toilet
Daytime and/or nighttime accidents
Small volumes of urine with each void
Possible triggers?
Stress or anxiety
Constipation
UTI
Delayed or inconsistent toilet training
Underactive Bladder
What is it?
Underactive bladder means the bladder does not empty often enough or completely. Some children may not feel or respond to the urge to go, which can lead to overstretching of the bladder muscles (called the detrusor muscle) over time.
Common signs?
Infrequent urination (ex: 2-3x a day)
Large volumes of urine when they do not go
Straining or pushing to urinate
Weak or interrupted urine stream
Dribbling or leaking between bathroom visits
Frequent UTI
Saying they “never have to go to the bathroom”
Possible triggers?
Holding behaviors
Chronic constipation interfering with the bladder signals
Neurological issues (rare)
Delayed or inconsistent toilet training
Pediatric Pelvic Floor Physical Therapy
Pediatric pelvic floor physical therapy is a non-invasive approach that can help children with both overactive and underactive bladder patterns. Therapists use age appropriate exercises and behavioral strategies to teach kids how to recognize and control the muscles involved in urination.
What interventions are used by physical therapists?
Teaching healthy bladder habits
Improving pelvic floor muscle coordination
Reducing urgency, leakage, or straining
Establishing regular, complete voiding routines
Addressing related issues like constipation