What is a weak bladder?

I’d like to discuss the question that a grandmother poses about her 9 year old grandson. His mother was told by his doctor that he has a “weak bladder” and that was the reason for his nighttime and occasional daytime wetting. She wonders what this is and what they can do to help him.

First of all, I don’t think that “weak bladder” is a description for any specific medical condition. Your grandson’s doctor may have used this as a generic term for an uncoordinated urinary system. The urinary system is quite complex, with several components innervated by different sets of nerves. In order to be completely dry during the day and night, quite a lot of coordination needs to take place. A good thing to know is that in the majority of children with nighttime wetting, the urinary system is completely normal. It’s the coordination of the different components that takes time and in some cases, some “nudging”, through the use of a timed voiding program or the use of bedwetting alarm in the nighttime. The actual bladder capacity (the amount the bladder holds before it perceives that it is full) varies from person to person and may necessitate your grandson getting up to use the bathroom in the nighttime or go a little more frequently in the daytime.

In the nighttime, children with bedwetting release the urine at a time when they are still asleep. The coordination between the brain and bladder hasn’t quite developed to the point where they “hold it” until morning or until a time when they can be more easily alerted. Bedwetting alarms work to alert the child and parents when the wetting is occurring. Over time, the sound helps the brain make the association between a full bladder and getting up to urinate. Bedwetting alarms harmlessly speed up this natural progression so that children can become dry over a few weeks or months rather than a few years.

Children with occasional daytime wetting often receive “urgent” messages from their overfull bladder. If there isn’t immediate access to a bathroom, the urine is released into their underwear. A successful strategy to help avoid this embarrassment is to empty the bladder on a regular basis, before it gets overfull. A vibratory wrist watch with programmed times (about every 2 hours) can be a helpful, discreet reminder to the child that they need to take a break and go to the bathroom. A watch also takes the parent or teacher out of the loop, so they don’t have to be the ones always doing the reminding. Of course, a child can choose to ignore the reminder, but in my experience, once a child is given the tools to make a change, most would gladly go to the bathroom than wet themselves.

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