Pediatric Daytime Urinary Urgency: Small Bladder or Pelvic Floor Trigger?
Lauren Rudko, PT, MSc PT
Pediatric Pelvic Physiotherapist
Daytime urgency, or the intense feeling of needing to urinate frequently, can affect children just as it can adults. While it might be tempting to look directly at the bladder for the reason why this is happening, it is also important to look at what might be happening to the pelvic floor as it works very closely with the bladder. The root causes of increased urinary urgency in children are similar to those in adults, however the way that we address pelvic health concerns in children is non-invasive and sometimes requires a little more detective work than in adults. Continue below to see how we can unpack the causes of daytime urgency, unpacking bladder concerns from pelvic health concerns.
Summary Points:
Pediatric daytime urinary urgency can be caused by bladder related factors and/or pelvic health related factors
A pediatric pelvic health physiotherapist can create an individualized plan to address daytime bladder urgency
How can “bladder size” affect daytime urgency?
Many adults will say that they have a “small bladder” and that their body has been this way since they were children. What’s interesting to know is that the bladder is a muscle and its capacity can be trained to some extent, with our habits having an impact on its “capacity”. Frequent urination and/ or routine “just in case” peeing can send signals to our brain that we will void when our bladder is not at full capacity - resulting in our bladder sending us signals that it doesn’t have to hold more than a small amount. A good practice is to ensure that we allow our bladder to fill fully before emptying it fully (note: there are exceptions to this general rule, like peeing before a long car ride or at a rest stop when one might not be available for a while after).
What other bladder factors can affect daytime urgency?
There are a few other things that can affect the bladder and cause increased urgency even if a child is on a regular voiding schedule of allowing their bladder to fill completely before emptying. The first is constipation, which can result in the stool that is filling up the intestines pressing down on the bladder and making it more difficult for the bladder to expand fully, confusing the signals being received by the brain and creating the feeling of urgency.
A second factor to consider if your child is experiencing urgency is if they are consuming a lot of bladder irritants. Bladder irritants are things that irritate the lining of the bladder, making it want to flush itself out and creating a sense of urge so that the bladder has an opportunity to empty. They include food and fluids that are: carbonated, caffeinated, spicy, citrus or contain alcohol. An interesting thing to note is that milk can also be a bladder irritant. All bladder irritants affect each person differently so an individualized approach is needed.
How does the pelvic floor affect daytime urgency?
The bladder works closely with the pelvic floor and its function cannot be separated from the pelvic floor muscles. The pelvic floor muscles can hold increased tension, just like any other muscle in your body (think about how your shoulders might tense up when you’re stressed). What’s unique about the pelvic floor muscles in how they relate to our nervous system is that they are one of the first places to tense up when we are feeling stressed, anxious, nervous or scared. Due to the amount of nerves in the pelvic floor, tension in that area can be interpreted by the brain as pain, burning, pressure… and you guessed it, the feeling of bladder urgency. You might have already experienced this phenomenon yourself if you’ve felt the increased and sudden urge to urinate before a big meeting or getting on a flight even if you have just gone to empty your bladder a few minutes before. In a child, stressors that could trigger increased tension in the pelvic floor could include anxiety before a test or a sports game.
How can pelvic physiotherapy help with daytime bladder urgency?
Pediatric pelvic health physiotherapy can help with all of the factors discussed above that can lead to daytime urinary urgency. A holistic, individualized, non-invasive approach is used to figure out why the child is having increased urgency and age appropriate play-based strategies are used to give the family tools to address the urgency. This may look like asking the family to complete a bladder diary on behalf of the child in order to take a closer look at their voiding and fluid habits to create a plan addressing anything that might be triggering urgency. It will also likely include full body and breathing exercises that can help decrease any tension held in the pelvic floor. Consulting with a pediatric pelvic health physiotherapist is one of the best ways to support your child if they are experiencing urge urinary incontinence. The team at Proactive Pelvic Health Physiotherapy Center is always happy to help!