Bladder

Urinary System Anatomy
Normal Voiding Values
Bladder Dysfunction
Investigating Tools
Urinary System Anatomy
The function of the urinary system is to filter blood and
then create urine as a waste product.

It consists of:


- 2 kidneys

- renal pelvis

- 2 ureters

- a bladder and

- urethra


All the cells in our body need water to work properly. The kidneys remove waste and extra water from your blood and turn it into wee. The wee trickles down the two tubes called ureters and gathers in a stretchy balloon called your bladder.
As the bladder fills with urine, its stretches and send messages
to the brain that you want to wee.

When it is the appropriate time and place, the holding on muscles (called the pelvic floor muscles) will let go and the bladder muscle will contract,
and urine will flow from the urethra.

As soon as the bladder is empty, the bladder muscle will relax and the holding on muscle will contract, helping the bladder to start with the storing phase of urine.


The Brain is Controlling the Bladder to Store or to Empty Urine

  • Normal Voiding Values
    - Baby’s will urinate frequently every 1-2 hours but small amounts of urine

    - Ideally a child will be dry at day from the age of 4 years

    - From the age of 5 years children can be continent both by day and night with increasing bladder volumes

    - Normal urinary frequency is 4-7 times in 24 hours
  • Bladder Dysfunction
    Night-Time Enuresis (NE)

    Night-time enuresis is discrete episodes of urinary incontinence in children during their sleep.
    Some children have never achieved 6 months of continuously dry nights, and it can be due to medical reasons for e.g:

    - Nocturnal polyuria: Increased urine production while asleep
    - Decreased bladder capacity
    - Detrusor overactivity – an irritated bladder muscle
    - Associated sleep arousal disturbances
    - Global maturation delay

    Genetics:
    - 75% incidence of NE in children when both parents had a history of NE
    - 50% when only one parent had history of NE
    - 15% when neither parent had a history of NE
    Some children attained at least 6 months of night-time dryness but now have a relapsed,
    Causes can be for e.g.:
    - Diabetes
    - Constipation
    - Psychological disturbances
    - New baby/ New school
    - Urinary tract infections (UTI)
    - Obstructive sleep apnoea
  • Constipation: Reason for bedwetting & pee accidents
    According to Dr Steve Hodges A CLOGGED, STRETCHED RECTUM is the reason for bedwetting and pee and poo accidents

    Learn more
Normal Voiding Values
- Baby’s will urinate frequently every 1-2 hours but small amounts of urine

- Ideally a child will be dry at day from the age of 4 years

- From the age of 5 years children can be continent both by day and night with increasing bladder volumes

- Normal urinary frequency is 4-7 times in 24 hours
Bladder Dysfunction
Night-Time Enuresis (NE)

Night-time enuresis is discrete episodes of urinary incontinence in children during their sleep.
Some children have never achieved 6 months of continuously dry nights, and it can be due to medical reasons for e.g:

- Nocturnal polyuria: Increased urine production while asleep
- Decreased bladder capacity
- Detrusor overactivity – an irritated bladder muscle
- Associated sleep arousal disturbances
- Global maturation delay

Genetics:
- 75% incidence of NE in children when both parents had a history of NE
- 50% when only one parent had history of NE
- 15% when neither parent had a history of NE
Some children attained at least 6 months of night-time dryness but now have a relapsed,
Causes can be for e.g.:
- Diabetes
- Constipation
- Psychological disturbances
- New baby/ New school
- Urinary tract infections (UTI)
- Obstructive sleep apnoea
Constipation: Reason for bedwetting & pee accidents
According to Dr Steve Hodges A CLOGGED, STRETCHED RECTUM is the reason for bedwetting and
pee and poo accidents
Read more

Deep Sleep


Children with healthy bladders simply do not need to pee overnight. Because human beings typically do not eat or drink overnight, we do not produce enough urine to need to pee. A

healthy bladder has the capacity and stability to hold the urine we do produce. When a person — child or adult — needs to pee overnight, it is because his or her bladder is overactive; in other words, the bladder spasms when it is not full, often with little warning. In children, virtually all bladder overactivity is directly caused by constipation; the stool-stuffed rectum squishes the bladder, shrinking bladder capacity and irritating the spinal nerves that supply the bladder. There can also be is a delayed communication between the bladder and brain or “underdeveloped bladder” where an overactive bladder spasm too quickly for the child to react. It is like a hiccup: You cannot stop it. Even when fully awake, many chronically constipated kids cannot make it to the toilet in time to avoid an accident. So, if a child sleeps when the bladder hiccups, what chance does this child have of jolting awake and sprinting to the toilet? None! The theory that deep sleep causes bedwetting conveniently overlooks the proven connection between bedwetting and daytime accidents. Children, by contrast, experience dynamic, abrupt bladder spasms. So, boom: wet sheets.

If a toilet-trained child is wetting the bed, it is a sign of an overactive bladder and/or low

bladder capacity. But the bladder is small because the clogged rectum is squishing it not because the bladder is “underdeveloped.”

See website
Investigating Tools
A rectal diameter of >3 cm indicates constipation
Investigating Tools: KUB X- Ray (kidney, ureters, and bladder) X-Ray
  • The colon will always contain some stool but the primary place to look for excess stool is the rectum. A normal rectum is less than 3 cm in diameter. If it is greater than 3 cm in diameter, the child is constipated

Pelvic health physiotherapy can be very surprisingly effective at helping your child overcome bowel or bladder challenges. The physical benefits to your child are huge…but the best gifts of all are that of self-efficacy, self-esteem, and self-confidence.