Overactive bladders

An overactive bladder is a condition that can cause sudden urges to wee (urinate) that may be hard to control. On this page, we’ll discuss common symptoms and treatments for overactive bladders in children.

What is an overactive bladder?

Bladder overactivity is when the stretchy-squeezy (Detrusor) muscles squeeze when they shouldn’t. This can lead to:

As the same symptoms can be caused by constipation / UTI / concentrated wee / caffeinated drinks / drinks which are bladder irritants for your child, it is essential to work through the 4 steps to a healthy bladder first. A diagnosis of bladder overactivity can only be made when healthy bladder management is in place.

Overactivity is very common in childhood. It is usually idiopathic – in other words it is just one of those things, there isn’t a particular cause – but it can occasionally be caused by an underlying condition. It is important therefore that your child has a physical examination to rule out an underlying condition before starting treatment. Have a look at Daytime Bladder Problems for more information.

This page includes information on overactive bladders, how they are diagnosed, and common treatments.

How will I know if my child has an overactive bladder?

If you’ve carried out the steps to healthy bladder management described on the Children’s bladders page and your child is still experiencing frequent wees, urgency to get to the toilet, small volume wees, or are wetting themselves, then they might have an overactive bladder. Now the process of diagnosis can begin.

The first step will be to fill in a very accurate Intake-Output Chart. You will need to complete at least two days, preferably three – choose days when your child is at home all day so you can make sure every detail is noted.

Some doctors and nurses have access to an investigation called uroflowmetry, where your child will be asked to wee into a special toilet which measures the speed of the wee coming out and the time it takes. The pattern for a child with overactivity is usually a high flow rate wee, passed in a short time.

Some doctors and nurses like to check how well your child is emptying their bladder before starting treatment. This is because the treatment relaxes the bladder – and if it relaxes too much, it might not empty completely. Bladder emptying is checked by ultrasound, which might be done with a portable, handheld bladder scanner, or in the x-ray department. Bladder scanning doesn’t hurt – children often call it a ‘jelly on the belly scan’ as special gel is used to get a clear image – and it is a very quick test.

Some children with underlying conditions, or functional problems that have not responded to treatment, will have a more complex bladder test called urodynamics. This involves catheters being placed in the bladder and the rectum, which are then connected to a special computer. Urodynamics will show detrusor overactivity very clearly, but the test is only recommended in a small number of children because it is so invasive.

How are overactive bladders treated?

Overactivity might be treated with:

  • Medication - these medications work in different ways, but both types stop the bladder squeezing when it shouldn’t:
    • An anticholinergic such as Oxybutynin, Tolterodine or Solifenacin
    • A medicine called Mirabegron.
  • TENS (Transcutaneous Electrical Nerve Stimulation) – the same treatment that is used in adults for pain relief/during pregnancy or labour. It works by interrupting the nerve impulses which are making the bladder squeeze when it shouldn’t.
  • PTNS (Percutaneous Tibial Nerve Stimulation) is the same principle but uses an acupuncture type needle in the tibial nerve in the ankle, rather than the sticky pads on the back used in TENS.
  • If the medication and/or TENS are unsuccessful, your child may be offered Botox injections into the bladder. These paralyse the bladder muscles and stop them squeezing when they shouldn’t. The Botox might also stop the bladder squeezing to empty properly, so your child may need to learn Clean Intermittent Catheterisation (CIC) – in other words gently inserting a catheter via the urethra to drain the wee, usually done several times a day. This is specialist treatment so your child would be seen by a Urologist. They will explain everything you and your child need to know.

How long will the treatment last?

Every child is different, and every specialist centre has their own treatment protocols, so the type and duration of treatment will vary.

  • Medication might only be needed for a few weeks – it might interrupt the bladder misbehaviour and stop it happening. Or it might be needed for many months or even years.
  • TENS and PTNS are usually delivered over about 12 weeks. Some children find their symptoms have resolved after a course of treatment. Others need to continue the treatment for a longer period of time.
  • Botox usually wears off after 6 – 9 months. The injections maybe need to be repeated, or it is possible for a single dose to correct idiopathic overactivity.

It can take time to work out the best treatment for your child – and they may need more than one type of treatment to get their overactivity under control. Remember, all the treatments work best if your child has a healthy bladder, so keep working on the 4 steps. If your child’s symptoms seem to get worse at any point, always suspect constipation or UTI, and check that their drinking is okay and that they are making time for regular, relaxed toilet sits. The basic steps are always important, whatever your child’s diagnosis.

Last Reviewed: October 2025

Next Review: October 2028

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