Bladder Training as a Behavioral Treatment for Children

Bladder training is a behavioral treatment that may be effective in eliminating bedwetting (or enuresis) among children. Bladder training seeks to increase the capacity of the bladder and the strength of the muscles used to retain urine in children and reduce the chance of accidents overnight. Learn how bladder training can be an effective bedwetting treatment in kids who still have problems.

A boy sleeping in his bed with his teddy bear
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What Is Bladder Training for Bedwetting?

Bladder training involves a program of increasing the capacity of the bladder through a combination of awareness and muscle strengthening exercises. If your child is motivated to stop bedwetting, bladder training might be a reasonable option.

Nocturnal enuresis (bedwetting) is a complex result of multiple factors. although some children have been found to have lower bladder capacity, other factors such as delayed maturity, genetic factors, disturbed sleep, and overactivity of the detrusor muscle (which contracts to push the urine out of the bladder into the urethra) are also involved.

The initial step is to focus on the amount of time that your child can "hold it" when the sense to pee first occurs. This effort to retain urine in the bladder helps to strengthen the muscles needed to prevent accidents that occur with bedwetting. In time, the ability to delay urination will increase with awareness and practice.

As part of this, it is useful to record the amount of urine that is passed after the delay has been attempted. The urine can be collected in a plastic urinal available at medical supply stores or some pharmacies. This collection can be done once per week and tracked in a diary. The target bladder capacity in ounces (1 ounce = 30 mL) is 2 plus your child’s age in years (up to 10 years old). For example, a 6-year-old child should have a bladder capacity of 8 ounces or 240 mL.

Is Bladder Training Right for My Child?

Bladder training may require a fair amount of motivation on the part of your child. It is clearly effective in increasing bladder capacity, but the impacts on bedwetting are less certain with mixed results in research studies. It might be a useful adjunctive therapy to other behavioral treatments or the use of medication, however.

It is important to recognize that some children have bedwetting due to unrecognized sleep disorders, including obstructive sleep apnea. If your child snores, this might be a sign that the bedwetting is actually an unexpected sign of sleep apnea. In this case, the treatment would be different.

If your child was previously dry but bedwetting had returned, you should speak with your pediatrician as this could represent a different disorder. Some children with persistent bedwetting and urinary problems may need evaluation by a urologist to ensure there are no abnormalities with the anatomy.

Are There Other Options?

In parents who wish to avoid using medications in their children, there are also other behavioral treatment options available for bedwetting. These options include:

  • Motivational therapy
  • Fluid management
  • Bedwetting alarms

Before trying bedwetting alarms or prescription medications, bladder training exercises might be a useful first step to treat problematic bedwetting. If the problem does not resolve, consider getting a further evaluation by a pediatrician. In some cases, it may be necessary to see a sleep specialist or a urologist to fully resolve the problem.

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  • Glazener, CM et al. "Simple behavioural and physical interventions for nocturnal enuresis in children." Cochrane Database Syst Rev. 2004.
  • Jalkut, MW et al. "Enuresis." Pediatr Clin North Am. 2001;48(6):1461.
  • Koff, SA. "Estimating bladder capacity in children." Urology. 1982;21(3):248.

By Brandon Peters, MD
Brandon Peters, MD, is a board-certified neurologist and sleep medicine specialist.