Bladder Control Problems in Children

Urinary Incontinence, Bedwetting, UTIs, and More

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There are many reasons children may have issues with toilet training. Some children go to the bathroom too frequently or not enough, while others experience urine leakage, bedwetting, or frequent urinary tract infections (UTIs). Finding the cause and treating the problem is the Duke Children's pediatric urology team’s main goal. Working with other specialists as needed, we help kids gain or regain their bladder control, reduce UTIs, and feel better mentally as well as physically.

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Diagnosing Bladder Control Problems

Careful Diagnosis Needed to Uncover Cause
While some bladder control problems may be related to behavior or development issues, others are due to a physical concern or birth defect of the urinary tract. Careful diagnosis can uncover the cause of painful urination, poor bladder control, and/or recurrent UTIs and may identify conditions that affect the bladder and sphincter muscles that control urination. Urologists will also inquire about your child’s bowel habits because bladder and bowel function are closely related. A proper diagnosis by our experienced pediatric urology team ensures your child receives personalized treatment that cures the condition, when possible, and allows them to live more fulfilling lives.

Comprehensive Physical Exam
A comprehensive physical exam gives us important information about your child's bladder and bowel function. The physical exam includes simple tests of your child’s lower-body reflexes, muscle strength, and sensations to check for any brain or nerve problems. Additionally, an abdominal and genital exam will be performed. Our team aims to be discrete and sensitive to you and your child's concerns. 

Your child’s urologist may also recommend:

  • Blood and urine tests to look at kidney function and rule out infection
  • An ultrasound to examine the urinary tract (bladder and kidneys)
  • An MRI to look for kidney, bladder, or spinal cord problems that could affect urinary and bladder function

We Are Thorough but Avoid Unnecessary Testing
Depending on your child's symptoms and test results, we may use other tests to take a closer look at how your child’s bladder, kidneys, and urethral sphincter muscles function. Our goal is to be thorough but to avoid subjecting your child to unnecessary testing.

Our Locations

Duke Health offers locations throughout the Triangle. Find one near you.

Tests and Procedures

Bladder Scan

A small ultrasound machine detects how much urine is in the bladder before and after urinating to see how well the bladder empties. This quick and painless test is done in the clinic room and takes only a couple of minutes.

Uroflow with Electromyography (EMG)

This is an easy, painless test that measures the flow and force of the urine stream as the bladder empties. Sensor patches on your child's abdomen and buttocks measure how the muscles work during urination. The test, combined with the bladder scan, also tells us how much urine is in the bladder, how fast and how completely it empties, whether the stream stops and starts, and how much urine is left in your child's bladder after urination.

Pelvic Floor Biofeedback

Some problems with urination are caused by children not properly relaxing their sphincter muscle when urinating. Sensor patches attached to your child’s hip and buttocks painlessly monitor your child’s sphincter muscle activity. To make the process fun and effective for your child, a video game is used to teach your child to better tighten and relax their pelvic muscles. The sessions are typically repeated monthly until your child masters the muscle relaxation. Biofeedback can also help children overcome constipation. 

Percutaneous/Posterior Tibial Nerve Stimulation (PTNS)

This nonsurgical treatment helps and may cure an overactive bladder and urinary incontinence. During a session, your child will relax in a chair while elevating one leg. A tiny electrode is inserted in the ankle, sending gentle electrical pulses up the leg to stimulate the group of nerves that control the bladder and block the signals that cause bladder spasms. Initial treatment includes 30-minute sessions that take place about 12 times over several months. Additional sessions may be necessary.


Bladder symptoms are often related to constipation. If a plain X-ray of the abdomen determines constipation is a problem, we can prescribe over-the-counter medications to treat and prevent constipation. For children struggling with frequent or urgent urination or having accidents, medications are sometimes prescribed to relax the “overactive” bladder and prevent bladder spasms. Constipation can be a side-effect of these medications, which is another reason we pay special attention to managing the bowels. Additional medications are sometimes used to promote better bladder emptying.


For children who do not respond to our initial procedures or have more complex issues, urodynamic testing may be recommended. This test is done to define how your child's bladder and urethral sphincter muscles work as they collect, hold, and release urine. This helps doctors discover why a child is leaking urine or having UTIs. 

Your child will urinate into a container that measures how fast it flows and how much is produced. Next, the doctor inserts a small catheter into your child's bladder through the urethra to measure any remaining urine. Then we will fill your child’s bladder with water and X-ray dye. This allows doctors to see how much their bladder can hold, when they have an urge to urinate or involuntary urination, and examine what happens when the bladder empties.

X-rays are often taken during the procedure to provide additional information about the bladder and urethra. Your child will be awake and alert so they can tell us about their bladder sensations.

Botox® Injections

Botulinum toxin (Botox®) injections into the bladder can help relax muscles and stop spasms in children with overactive bladder or bladder spasms that do not respond to medications. Botox® effects last between six and 12 months and may need to be repeated. This procedure is typically done in an operating room under general anesthesia.


In rare cases, surgery may be recommended to correct birth defects, such as ectopic ureter, or reconstruct the bladder and/or urethra.

Treating Bladder Control Issues Common in Children

Your Child's Comfort and Convenience Is Our Concern
Because our pediatric urology team works closely with other pediatric specialists, we’re able to make your child’s visit as convenient and comprehensive as possible. This collaboration means you don’t need multiple visits to address the problem. For example, if your child experiences bladder control problems and constipation, we can arrange for your child to receive care from a pediatric urologist and a pediatric gastroenterologist. Likewise, if bladder control is related to diabetes, your child’s care team will include a pediatric endocrinologist. If nerve issues are found, we may involve pediatric neurologists or neurosurgeons.

Psychological and Social Support
We know your child may feel embarrassed and ashamed or experience low self-confidence. Our pediatric psychologists, counselors, and social workers can help your child learn to cope, especially if they are having difficulty while they’re at school or in social situations.

Child Life Specialists
Invasive tests are rarely needed for most children but, when required, some tests can be frightening to children. We strive to put your child at ease. Our child life specialists explain the procedure and offer encouragement. We help prepare your child and offer support if your child needs a test or minimally invasive procedure.

Best Children's Hospital in NC

Duke Children's Hospital & Health Center is proud to be nationally ranked in 10 pediatric specialties.

This page was medically reviewed on 04/02/2024 by