Step One:
Accurate Diagnosis

The key to successful resolution of your child's bladder dysfunction is accurate diagnosis. What is the root of the problem?  Some examples include  (1) weakness or incoordination of the muscles of the pelvic floor (2)  Problems with the neural control involved in sensation that the bladder is full or controlling contraction of the bladder wall to evacuate.
Most of this information can be attained from clinical history (including specialized questionnaires) and bladder diaries ( written documentation of fluid intake & output).  Sometimes your doctor will  request a specialized diagnostic test such as uroflowmetry or a bladder ultrasound.   These are noninvasive tests.

Step 2: Treatment Program

The ICCS (International Children's Continence Society = The Gold Standard of Medical Management in Pediatric Pelvic Health) recommends urotherapy as the first-line treatment tin all types of daytime urinary incontinence. 

What is urotherapy?
Urotherapy involves  (1) Educating the client about the anatomy and physiological mechanisms involved in filling & emptying the bladder.  This sets the stage for retraining the specific aspects that may not be working optimally for this given child. (2) Retraining sensory and motor mechanisms involved in filling and emptying of the bladder (3) Lifestyle/Behavioural modifications.  This may include a voiding (emptying) schedule for the bladder or specific fluid and dietary recommendations.

Step 3:
Biofeedback (if required)

One of the factors contributing to pediatric incontinence is often related to lack of strength or coordination of the muscles that make up the pelvic floor. The pelvic floor muscles comprise of a dome of muscular tissue in the pelvis that supports the urethra (tube from the bladder to the outside) and whose contraction contributes to the mechanism that keeps fluid inside the bladder. Simplistically, we can use a water balloon analogy. The water balloon resembles the structure of the bladder, continuously fluid filling with fluid. In order to keep the fluid in the water balloon, a sufficient closure mechanism is required at the base of the bladder/balloon. This is the function of your pelvic floor muscles.

In children whose pelvic floor muscles are weak we often use animated biofeedback where they can see (in real time) the performance of their pelvic floor muscles. Using surface electrodes (or stickers on the skin) we can measure contraction an relaxation of the pelvic floor muscles. the child by either contracting or relaxing these muscles can move the icon on the screen to play a video game. it is a whole lot of fun! Even my adult clients thank you playing a video game with their pelvic floor muscles is a lot of fun.

Step 4: Ultrasound Lab if required

Constipation is a contributing factor in a multitude a pediatric bowel and bladder dysfunctions. Constipation can be a driving factor in your child's bedwetting (enuresis) or fecal leakage (encoporesis or poop leaks). Constipation can even impair Normal bladder functionality leading to daytime leaks as well. And trust me it is not easy to tell if your child is constipated. However, the gold standard assessment technique is to use transabdominal ultrasound to measure the rectal diameter. A transverse rectal diameter greater then 30 millimeters indicates a diagnosis of constipation.

Now in our ultrasound lab under the direction of your child's physician or specialist we can attain these measurements of your child's rectum to determine if constipation is contributing to his or her bowel and bladder problems. Ultrasound is a noninvasive investigative tool

Santos JD, Lopes RI, Koyle MA. Bladder and bowel dysfunction in children: An update on the diagnosis and treatment of a common, but underdiagnosed pediatric problem. Can Urol Assoc J. 2017 Jan-Feb;11(1-2Suppl1):S64-S72.