Bladder Function Improvement Training (BFIT) Program

The Bladder Function Improvement Training (BFIT) Program is a comprehensive approach to managing dysfunctional bladder emptying (urinating) and includes expertise in the treatment of nighttime wetting. Our program also treats vesicoureteral reflux. Children referred to our program are evaluated and managed by our experienced urology nurse practitioners and urologists.

Learn more about nighttime wetting in our "Ask the Expert" video below.

Many children with dysfunctional voiding show poor pelvic floor muscle relaxation caused by “holding it.” It is a learned behavior that develops over time, leading to an abnormal urine stream and poor emptying of the bladder. While dysfunctional bladder emptying happens in the voiding phase, a child will often have symptoms when not voiding, such as wetting. In most children, voiding problems can be treated without surgery.

Signs that your child has dysfunctional bladder emptying include:

  • Frequent urine holding
  • Daytime wetting
  • Nighttime wetting
  • Urinary urgency or frequency
  • Constipation
  • Urinary tract infections (UTIs)
  • Behaviors that exhibit holding of urine. For example, female children will “curtsy,” or cross the legs and bend from the waist to avoid urinating

The Lurie Children’s Difference

We work together with you and your child to develop an individualized treatment plan that meets your child’s specific needs. Your child will receive world-class clinical care combined with a compassionate approach to make them more comfortable during the process. We collaborate with patients and their families until a successful outcome is achieved, taking time at each visit to ensure all questions are answered.

What to Expect on Your First Visit

Your first visit will include both you and your child. You will be asked to complete a three-day voiding diary (file is also available in Spanish) which provides important information about your child’s fluid intake and bathroom habits. If your child has had any testing done related to their bladder function, you should bring reports and CDs of that testing with you to your first visit. This may include copies of urine testing or ultrasound of kidneys or bladder. You can obtain the CDs from the facility that did the original testing.

Dysfunctional voiding is primarily diagnosed by reviewing a thorough patient history with emphasis on toilet habits. An ultrasound of the kidneys and bladder may be used to look for rare structural abnormalities. An abdominal x-ray may be used to evaluate for stool retention. Further evaluation may include pre-void and post-void ultrasounds to assess for residual urine. A uroflow with EMG test may be performed to evaluate the activity of your child’s pelvic floor muscles with voiding. This test may show poor pelvic floor muscle relaxation causing abnormal urine flow.

After the initial visit, follow-up visits may occur every 6-8 weeks, or more frequently, depending on the child’s needs. The number of visits needed depends on how quickly symptoms improve with management.


Treatment for dysfunctional voiding involves a multi-pronged approach individualized for each child. The components of treatment include:

  • Behavior Modification
    • Relaxation/Repositioning: Children are taught proper toilet positioning and techniques to promote pelvic floor relaxation to strengthen their ability to release urine in a relaxed and complete manner.
    • Alarm Training: In alarm training, children with nighttime wetting are given a device to wear at night that includes a sensor that clips to their underwear attached to a speaker that attaches to their pajamas. When a child starts to wet at night, the alarm rings, waking up the child and parent, who will send the child to the bathroom. This alarm helps recondition the brain and bladder to communicate at night. With consistency and determination from parents and children in using this alarm, most patients see improvement within 3-4 months. Learn more about this approach with this video.
    • Timed Voiding: Children with dysfunctional voiding may not receive strong messages that signal when the bladder is full and may need a schedule to re-train the bladder.
    • Biofeedback: When repositioning and timed voiding do not improve pelvic floor function, biofeedback training is implemented on an age-appropriate level. This means teaching a child how to read their own body and understand how the body works.
      • Working with the Lurie Children’s expert pediatric physical therapists, information on a child’s voluntary contraction and relaxation of the pelvic floor feeds back to a computer program with videogame-like output. In other words, by squeezing and relaxing the pelvic floor, the child manipulates a character through a simple video game. Core strengthening is also incorporated. This teaches the child how to isolate and relax the pelvic floor muscles, which can help correct bedwetting and/or daytime wetting. These sessions last about 45 minutes, and children usually require 4-6 sessions. Families are taught how to complete exercises at home which is key to success. Learn more about biofeedback training.
  • Bowel program: Children with dysfunctional voiding do not appropriately relax the pelvic floor muscle and these are the same muscles that control the release of stool. Learn more about preventing stool retention.
  • Antibiotics: Children with recurrent UTIs may be given low-dose preventative antibiotics.

Our Specialists

The BFIT program is managed by experienced pediatric practitioners that are specialized in treating urologic conditions: Kavita Hodgkins, MDDawn Diaz-Saldano, MSN, APN, CPNP; Lynn Freedman APRN-NP; Hope McGowan APRN-NP, PNP; Reumah Ravoori, MMS, PA-C. Board-certified urologists and kidney disease specialists provide leadership for the program and oversee patient’s treatment plans.


If you’d like to request an appointment with one of our specialists, call 1.800.543.7362 (1.800.KIDS DOC®) or visit our Appointments page for more information.