Bladder Retraining

How does the bladder work?

A baby does not decide when to empty, or void, his bladder; when it is full, the bladder empties. As children grow, they learn to control their bladders.


Bladder Control in Babies and Children
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In babies, urination is controlled by a simple reflex arc involving messages from the spinal cord, not the brain. In children, urination is controlled by the brain.

Good bladder control​ means that the brain and the bladder work together. The bladder tells the brain that it is getting full, and the brain decides to find a bathroom and empty the bladder.

Most children are able to control their bladders completely by the age of 7 years, but some children need more help.

Poor bladder control can result in:

  • urinary frequency, when a child needs to void many times during the day
  • urinary urgency, which is a sudden, almost uncontrollable need to void
  • urinary incontinence, when a child voids without meaning to

If your child cannot control his bladder, he may have accidents (wetting) during the day and at night. This can be embarrassing and frustrating for your child and for you.

What is bladder retraining?

Learning to follow a bladder routine can help make your child's voiding habit more regular. This can help your child in several ways:

  • Your child may avoid wetting and stay dry for a longer time.
  • Your child's feelings of having to void frequently and urgently may be less.
  • A regular voiding habit can help prevent bladder infections.

The following instructions are designed to guide you in helping your child retrain his bladder. Other family members may want to use some of these tips as well.

Before you start bladder retraining

Retraining your child's bladder takes time, understanding, and patience. Create a safe and supportive environment for your child. Together, you are developing strategies to overcome the problem. A relaxed, matter-of-fact approach will help.

Tips for bladder retraining

Your child should drink more during the day

Your child should drink more fluids (liquids) during the day. Water is the best clear fluid that your child can drink. It helps to flush the kidneys and bladder naturally.

  • As well as the milk and juice that your child normally drinks with meals, slowly increase the amount of water. Eventually, your child should drink 2 litres (eight 8-ounce glasses) of water during the day.
  • Large amounts of fruit juices may irritate your child's bladder. Most fruit juices are acidic. They may cause burning and itching when voiding. Try limiting fruit juice or diluting it with water.
  • You may need to ask your child's teacher to allow your child to drink more during the day. For example, ask the teacher if your child may keep a water bottle on his desk.
  • Your child may need special bathroom privileges at school until he has enough bladder control to go to the bathroom during regular school times. Ask the urology nurse or doctor for a school letter that explains this.

Your child should not drink much after 6:00 in the evening

Your child should drink most of his fluids between waking up and late afternoon (4:00 to 6:00).

  • A large amount of fluid in the morning helps to make sure there is enough urine in the bladder.
  • Drinking after 6:00 in the evening may make bedwetting worse.

Your child should try to void every 2 to 3 hours

Your child needs to develop a regular voiding schedule. Encourage your child to try to void every 2 to 3 hours, whether he feels the need to or not.

  • Your child should not hold urine for long periods of time. This may stretch the bladder muscles.
  • You may want to have the voiding schedule match the breaks in your child's school day (morning, mid-morning/recess, noon, mid-afternoon) and afterwards (early evening, late evening).

Your child should avoid caffeine

Your child should not eat or drink foods and drinks that contain caffeine.

  • Caffeine may irritate the bladder and cause frequency and urgency in voiding.
  • Common foods and drinks that contain caffeine are colas, Mountain Dew, tea, coffee, and chocolate.

Fibre is important

A high-fibre diet will help your child have a regular bowel routine and avoid constipation.

  • If your child is constipated, it is more difficult for the bladder to fill up with urine. It is also hard to empty the bladder completely. Constipation is a major contributing factor in children who have urinary tract infections and/or incontinence.
  • Foods that are high in fibre are fruits, vegetables, bran, cereals, whole wheat bread, rice, beans, and lentils.

Your child should do Kegel exercises

Bladder exercises can help to strengthen the muscles around the outlet of the bladder (the urethral sphincter). These exercises are known as Kegel exercises.

  • To help your child understand this exercise and feel these muscles, ask him to squeeze a ball the size of your fist between his legs, right above his knees.
  • When your child can feel these muscles, he should practice the Kegel exercises when he is not voiding.
  • Your child should practice the Kegel exercises twice a day. To help your child remember, try doing them after something he does every day. For example, your child could do the exercises after breakfast and dinner, or after homework.

Use a diary or calendar to track your child's progress

A diary or calendar helps to reinforce your child's efforts to retrain the bladder and stay dry. You can use stickers or checkmarks to keep track of when your child voids.

  • Help your child to make his own calendar. This will help your child develop a daily routine.
  • The stickers and praise help reinforce your child's efforts to stay dry.
  • The diary can also be used to keep track of your child's progress over a period of time, such as 6 months.

If you have further questions, please speak to your doctor or the urology clinic nurse.

Key points

  • Good bladder control means the brain and the bladder are working together.
  • Learning to follow a bladder routine can help make your child's voiding habits more regular and avoid wetting.
  • Retraining your child's bladder takes time, understanding, and patience.

Cathy Daniels, RN, MS

7/29/2009

At SickKids:

If your child has been referred to the urology program at SickKids for dysfunctional voiding (including recurrent urinary tract infections, incontinence, urinary frequency, or urinary urgency) and bladder retraining has been suggested, please:

  • follow this bladder retraining information
  • keep a voiding diary as described

If you have questions or concerns, please contact the Advanced Practice Nurses by calling the urology clinic at 416-813-6661.





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