What is dysfunctional voiding?

What are the symptoms of dysfunctional voiding?

  • Urinary frequency – your child voids at least every 2 hours (this can interfere with school and other activities
  • Urge incontinence – your child complains that they don’t realize they have to go until it is “too late” 
  • Non-specified incontinence – your child may leak urine without realizing it
  • Bladder spasms – these may lead your child to feel the urge to urinate, but be unable to do so once they get to the bathroom

Dysfunctional voiding can vary from mild to severe.  Mild dysfunction may be manifested by symptoms of urinary frequency and urgency and may even cause daytime wetting.  Dysfunctional voiding and constipation commonly occur together. 

Constipation refers to hard stools, not infrequent ones.  When children have hard stools they can be difficult and painful to pass.  This may lead to stool withholding; the child is reluctant to have a BM because it hurts, they “hold on” to the stool, this leads to rectal distension and even more hard stools.  As children become more and more constipated, the rectal distension can actually press on the bladder causing problems with urination.  For more information about how to break this cycle, see our “Why is my child constipated” handout. 

Dysfunctional voiding can also be due to a learned problem-as in the case where a child continually holds urine in all day. Children can get into this routine for different reasons. Some may be routinely too busy to break for the bathroom. Others may have experienced a urinary tract infection that caused bad pain and as a result are fearful of urinating. Sometimes the problem is related to potty training. A child may have taken on abnormal urinating habits from the beginning.

Whatever the reason, a child gets into a pattern of failing to relax the external urethral sphincter. The bladder can tolerate this for months and in some cases years, depending on how hard the child works to avoid urinating. Eventually the bladder muscle, which has to continually work against this voluntary blockage, will become so strong that it will overcome the blockage and periodically empty on its own, no matter where the child is at the time.

Treatment of this kind of dysfunctional voiding begins with a timed voiding schedule.  To do this encourage your child to void/urinate on awakening in the morning, every two to three hours thereafter, and before going to bed at night. You will also need to encourage your child to completely relax the sphincter with voiding which will allow the bladder to empty completely.  Double voiding (having your child void, wait a few seconds, and then try to void again) can also be very effective. 

Treatment of dysfunctional voiding can take time, and requires a great deal of patience.