What is detrusor instability?
Most children learn to inhibit or control their bladders between the ages of 18 months and four years old. The brain sends a message to the bladder to keep the bladder from contracting. When the bladder is full a signal is sent to the brain, and the child responds by going to the bathroom, relaxing the internal urinary sphincter, turning off the inhibition signal and voiding to the last drop.

Children with detrusor instability have bladders that won't listen to the signals being sent from the brain. The clinical picture is a child with urgency and incontinence on the way to the bathroom. If you ask these children if they can tell when they have to go to the bathroom they will answer "no," or "sometimes." This is because often, with no warning, their bladders will go into a contraction. One minute there is no sensation of fullness telling them to go to the bathroom, and the next minute their bladders are going into a contraction and they have to concentrate and clench their sphincters in order not to wet their pants. Little girls will often squat down on one foot to keep from urinating.
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How is detrusor instability treated?
The treatment approach for these children is a conditioning one. Most of these children will get better with time, even without treatment. Their bladders are experiencing a delay in making the jump from an uninhibited baby bladder to an inhibited adult bladder, but over time they will make that jump. The treatments we use are mostly to hasten the natural resolution. See our biofeedback and voiding retraining FAQ for more information on treatment methods.

When daytime wetting continues in an older child, we may choose to add some pharmacological therapy to help tone down the bladder and help the child gain some control over his or her bladder function. The bladder is a cholinergic muscle, so an anticholinergic drug, like ditropan, will take an overly tense bladder and relax it, improving the bladder capacity and making it less ready to go into an uninhibited contraction.
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