Profesionales médicos

Oct. 23, 2026

Specialists at Mayo Clinic Children's diagnose and treat dysfunctional voiding, a condition involving difficulty coordinating the muscles and nerves that enable bladder and bowel emptying. In children, this often leads to incomplete emptying, leakage or both.

The key challenge is distinguishing a one-time leak or "accident" from something that might be part of a larger clinical problem, as symptoms often appear after a period of normal continence.

"In most cases, this condition reflects a pattern of holding and incomplete voiding that develops after children have already been toilet trained," says Patricio C. Gargollo, M.D., a pediatric urologist at Mayo Clinic Children's in Rochester, Minnesota. While many children respond well to structured bladder-bowel retraining, recognizing the dysfunction and addressing it early is critical. "Our role is to help parents identify those habits and then support their child in relearning more-comfortable, effective bathroom routines."

Causes of dysfunctional voiding

The bladder and bowel share pelvic floor musculature and overlapping neural regulation. Normal emptying requires the appropriate sphincter to relax while pelvic floor muscles coordinate bladder and bowel activity. When this coordination is disrupted, urinary and bowel symptoms can occur together.

Given the close connection between bladder and bowel function, children with urinary symptoms often also have bowel-related issues, such as constipation. That's why evaluation should address both systems, even when the chief complaint is urinary.

"Continence depends on a highly complex network of muscles, nerves and internal body cues," Dr. Gargollo says. "Although there's no evidence of a single, uniform cause, any disturbance of that network can disrupt the entire process."

What was once an occasional diagnosis now appears in multiple children a day in the clinic. One theory points to prolonged use of digital devices.

"Kids who sit for long periods may habitually clench their sphincters and ignore bladder or bowel fullness," he says. "Over time, that pattern of holding and incomplete emptying can evolve into a clinical issue."

When accidents might indicate bladder or bowel issues

Diagnosing dysfunctional voiding can be challenging because occasional accidents are normal in young children. Concern often depends on how much symptoms disrupt a child's daily or social life.

The condition exists on a spectrum ranging from no symptoms or mild leakage to severe difficulty emptying the bladder or bowel. Diagnosis begins with collecting a detailed history to:

• Document symptoms. Focus on the onset, timing, frequency, severity and degree of urinary and bowel issues.
• Identify patterns. Clarify whether accidents occur mainly during the day or at night, possible triggers, and previous periods of normal continence.
• Screen for structural, infectious or neurological issues. Findings that should prompt closer evaluation or referral include the presence of severe or persistent abdominal pain, recurrent urinary tract infections (UTIs), or unexplained weight loss.

Dr. Gargollo says that all children referred to Mayo Clinic Children's for dysfunctional elimination undergo a series of baseline tests that help define the extent of their voiding issues:

• Abdominal imaging uses low-dose X-rays to visualize stool throughout the intestines and assess the extent of retention or incomplete bowel emptying.
• Bladder ultrasound measures how much urine remains in the bladder after voiding and confirms incomplete emptying.
• Uroflowmetry evaluates urine flow patterns, with normal patterns following a bell-shaped curve and jagged or "staccato" curves indicating dysfunctional voiding.

How dysfunctional voiding can affect kidney health

The same mechanisms that prevent complete bladder emptying can increase pressure throughout the urinary tract. In some children, this can contribute to urine flowing backward toward the kidneys, increasing the risk of infection and kidney damage. Recurrent UTIs, kidney stones, or blood or protein in the urine may signal complications affecting the kidneys.

"The most common presenting feature is recurrent UTIs, which often prompt referral and can be an early warning sign of underlying kidney risk," says David J. Sas, D.O., a pediatric nephrologist at Mayo Clinic Children's. "Chronic high pressure in the urinary tract and recurrent infections can damage the kidneys over time, leading to scarring and gradual loss of function."

Although severe outcomes are rare, they highlight the risks of a missed diagnosis. Dr. Sas explains that it's not uncommon for adolescents to present with hypertension or unexpected kidney failure, only for clinicians to discover long-standing, previously unrecognized dysfunctional voiding.

"Addressing dysfunctional voiding is often relatively straightforward," he says. "But early and accurate diagnosis is critical to managing symptoms and preventing progressive damage that may not become apparent until years later."

Strategies and therapies for bladder-bowel retraining

Dr. Gargollo explains that most cases of dysfunctional voiding can be managed conservatively in partnership with primary healthcare professionals by helping children "re-toilet train" so they empty their bladders and bowels completely and on a regular schedule. Practical strategies for bladder-bowel retraining include:

• Deep-breathing methods and adequate time on the toilet to support complete emptying.
• Double and triple voiding to clear residual urine.
• Increased dietary fiber or use of mild laxatives to support daily passage of stool.
• Scheduled bathroom trips every 2 to 3 hours while awake, including upon waking, during school, after school and before bedtime.

"When parents and children consistently follow these steps, new habits form that successfully address problems in over 90% of cases," Dr. Gargollo says.

When symptoms persist, advanced therapies can help retrain how the pelvic floor, bladder and bowel work together. These approaches are often used together:

• Biofeedback uses screens or animated games to show children how their pelvic floor muscles and urine flow behave during voiding. Children practice relaxing while voiding until the pattern is smooth and postvoid residual urine in the bladder decreases.
• Pelvic floor physical therapy reinforces child‑friendly breathing, relaxation and toilet posture to undo chronic tightening and holding behaviors.
• Medications may be added to reduce urgency and incontinence, making children less fearful of accidents and more willing to sit long enough to empty both their bladders and bowels.

For children with severe or refractory symptoms, Dr. Gargollo emphasizes the importance of timely referral to centers that offer advanced therapies tailored to pediatric patients.

"Specialized pediatric pelvic floor and biofeedback programs use the same core corrective strategies we rely on for milder cases," Dr. Gargollo says. "They're conceptually simple, but consistently applying these techniques and supporting children as they build new habits is often the most challenging work for families."

For more information

Refer a patient to Mayo Clinic.