Overactive bladder (OAB) in children

An overactive bladder (OAB) can cause urinary incontinence, which is the involuntary release of urine. An OAB can occur in both children and adults.

What are the signs of an OAB in children?

A child with an OAB needs to urinate frequently, and sometimes the urge may be urgent. He or she may not go to the bathroom until urine begins to flow.

What causes an OAB in children?

Children with an OAB need to urinate more often than usual because their bladder muscles contract uncontrollably. The muscles surrounding the urethra, the tube in the bladder through which urine passes, may be affected. These muscles are designed to keep urine from leaving the body, but they can be "locked up" if the bladder experiences a strong contraction.

Urinary tract infections can cause the need to urinate when the urinary tract becomes inflamed and uncomfortable. Some neurological conditions can cause these symptoms.

Another cause of an OAB is a condition called pollakiuria, or diurnal frequency syndrome. Children with pollakiuria urinate frequently. In some cases, they may urinate every 5 to 10 minutes or urinate 10 to 30 times a day. This condition is most common in children between the ages of 3 and 8 and is only present during waking hours. There are no other symptoms. Doctors believe pollakiuria is related to stress. The disease usually resolves in two to three weeks without requiring treatment.

Other causes of an OAB 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

How to treat an OAB in children?

In most cases, children outgrow the problem of an OAB. For each year after 5 years, the incidence of OAB decreases by 15%. The child may learn to respond more quickly to the body's signals to urinate, or the capacity of the bladder may increase over time. In addition, an OAB can "calm down", often after stressful events or experiences are behind them.

If the child does not outgrow the condition, treatment may include bladder training and medication. In bladder training, the child uses exercises to strengthen and coordinate the muscles of the urethra and bladder to control urination. Such exercises teach the child to avoid urinating away from the toilet and to anticipate the urge to urinate. Additional methods to help an OAB include:

avoid caffeine or other ingredients that may contribute to an OAB
use of scheduled urination or scheduled urination, for example, every two hours.
adopting healthy urination habits such as allocating enough time to urinate and relaxing the muscles while urinating

What drugs are used to treat OAB in children?

The drug oxybutynin is used to control problems such as urgent, uncontrolled, or frequent urination and other conditions that affect the bladder muscles. Oxybutynin relaxes the muscles of the bladder, preventing problems with urination. However, there are newer drugs that may have fewer side effects.

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

Is nocturnal enuresis associated with OAB in children?

Yes. Some of the same conditions or circumstances that make bedwetting more likely, combined with infrequent urination, can lead to daytime urinary incontinence. These conditions and circumstances include hard stool pressure or other causes listed above.

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

What additional methods can be used to treat bedwetting?

In the vast majority of children, bedwetting resolves on its own over time, so no treatment is needed. If bedwetting is a serious problem for a child, several treatments are available.

One treatment for bedwetting is dampness alarming. This device includes a water-sensitive pad with a wire connected to a control box. When moisture is detected, an audible signal is given to wake the child. In some cases, it may be necessary to have another person in the room to wake the child if he is not doing it alone.

Setting an alarm for your child to wake up to urinate - timed urination - can also help reduce bedwetting.

Another treatment option for bedwetting is medication. Increasing antidiuretic hormone levels can help treat bedwetting. Desmopressin is a synthetic version of the antidiuretic hormone. This medicine, approved for use in children, comes as a tablet, nasal drops, or nasal spray.

You can also use the drug imipramine. This drug affects not only the brain, but also the bladder. Approximately 70% of children who wet their bed can be helped with these medications, according to researchers.