About urinary incontinence in children

What is urinary incontinence in children?

Urinary incontinence in children facts

  • Urinary incontinence in children is very common.
  • Nighttime wetting (nocturnal enuresis) is more common than daytime wetting (diurnal enuresis).
  • Most urinary incontinence is nonorganic and resolves without intervention.
  • Persistent primary enuresis and secondary enuresis may require further medical evaluation.
  • Treatment for most cases of enuresis involves behavioral modification.
  • Bedwetting alarms are very effective.
  • Medications should be reserved for select children.
  • Less than 1% of all affected children have persistent incontinence into adulthood.

What is urinary incontinence?

Very simply stated, urinary incontinence is defined as the loss of complete control of the act of urination or the involuntary emptying of the bladder. It is also referred to as enuresis. It can be caused by any number of factors, and in young infants and toddlers, it is usually completely normal. In order to understand the different causes better, one must have some basic understanding of processes involved in urination

How does the urinary system work?

The urinary system is made up of the kidneys, ureters, bladder, and urethra. Urine is produced by the kidneys and drains via the ureters to the bladder. The bladder serves as the storage tank, stowing the urine until emptied through micturition (urinating). The act of emptying the bladder requires significant coordination between the brain, nerves, and muscles. There are two major muscles involved in urination, the detrusor and the sphincter. The detrusor is a large muscle which contracts to squeeze urine out of the bladder, and the sphincter is a group of muscles which remains contracted to keep urine in the bladder. These two muscles must work in concert, one contracting while the other relaxes, to control the flow of urine. Dysfunction in either may result in some degree of loss of urinary control. The urethra serves as the canal which carries the urine from the bladder during voiding. Achieving bladder control must be learned, and some children learn earlier than others, and therefore urinary incontinence is normal in most young infants and children, but in older children and adolescents, it is not considered normal.

What are the different types of urinary incontinence in children?

It is easiest to divide childhood enuresis into two groups. Nocturnal enuresis occurs during sleep and diurnal (daytime) enuresis occurs during waking hours. Nocturnal enuresis is often referred to as bedwetting and is the most common type of urinary incontinence in children over 5 years of age. Diurnal enuresis is more often seen in younger children and more often a result of certain behaviors, though rarely it can be a sign of more serious problems. Another way to categorize incontinence is by the timing of the symptoms. If a child has good daytime bladder control but has never had a dry night, it is referred to as primary enuresis. Secondary enuresis is incontinence in an individual who has been dry for at least six months and then develops symptoms after that period.

What are the symptoms for urinary incontinence in children?

Enuresis symptom was found in the urinary incontinence in children condition

It is easiest to divide childhood enuresis into two groups. Nocturnal enuresis occurs during sleep and diurnal (daytime) enuresis occurs during waking hours. Nocturnal enuresis is often referred to as bedwetting and is the most common type of urinary incontinence in children over 5 years of age. Diurnal enuresis is more often seen in younger children and more often a result of certain behaviors, though rarely it can be a sign of more serious problems. Another way to categorize incontinence is by the timing of the symptoms. If a child has good daytime bladder control but has never had a dry night, it is referred to as primary enuresis. Secondary enuresis is incontinence in an individual who has been dry for at least six months and then develops symptoms after that period.

What are the causes for urinary incontinence in children?

Any number of normal and abnormal things can cause nocturnal enuresis in children. Boys are more commonly affected than girls. Most young children who suffer from bedwetting are physically and emotionally normal. Although the exact cause is unknown, the bedwetting is believed to be the result of a number of nonorganic factors, including developmental issues, overproduction of urine, and an inability to respond to the normal physiological signals associated with bladder distension while asleep. Since bedwetting does run in families, experts believe there is a genetic disposition as well and if a parent experienced nocturnal enuresis as a child, there is a 45% risk that their child will also suffer from bedwetting. In addition to nonorganic causes, there are also some less common organic causes including infection, anatomic abnormalities, neurologic abnormalities, and endocrine abnormalities such as diabetes mellitus.

What are the treatments for urinary incontinence in children?

The treatment of urinary incontinence depends upon the underlying cause of the problem. The primary treatment for nocturnal enuresis most commonly involves behavioral modification. This involves positive reinforcement, encouraging frequent daytime voiding, and periodically waking the child at night, restricting fluid intake prior to bed, and alarm therapy with devices that wake the child when the underwear or bedclothes have become wet. In all cases, most children are already embarrassed by bedwetting and it is important try to reduce the social and psychological impact of the condition. Moisture alarm therapy has a high success rate and works best for motivated older children and parents. The basic process involves placing a probe in the undergarments or bed which alarms when it senses wetness. Most children will sleep through the alarm; however, most stop voiding when the alarm goes off. The child's parent must get up and help the child to the bathroom to encourage voiding, change the wet sheets and pajamas, and reset the alarm. Moisture alarms generally work within two weeks to three months and should be discontinued if the child's symptoms persist after three months.

What are the risk factors for urinary incontinence in children?

Urinary incontinence is the loss of bladder control. In children under age 3, it’s normal to not have full bladder control. As children get older, they become more able to control their bladder. When wetting happens in a child who is old enough to control his or her bladder, it’s known as enuresis. Enuresis can happen during the day or at night. Enuresis can be frustrating. But it’s important to be patient and remember that it’s not your child’s fault. A child does not have control over enuresis. And there are many ways to treat enuresis and help your child. The cause of night-time enuresis often is not known. But some possible causes may include one or more of these factors: • Not enough antidiuretic hormone (ADH) in the body during sleep • Obstructive sleep apnoea • Overactive bladder • Slower physical development • Small bladder • Structural problems in the urinary tract • Trouble feeling that the bladder is full while asleep • Urinary tract infection (UTI) • Very deep sleep • Anxiety • Attention deficit/hyperactivity disorder (ADHD) • Certain genes • Constipation that puts pressure on the bladder • Diabetes

Is there a cure/medications for urinary incontinence in children?

In addition to behavioral modification, there are some children who will ultimate require medication. Most commonly used medications include desmopressin acetate (DDAVP), oxybutynin chloride (Ditropan), hyoscyamine sulphate (Levsin), and imipramine (Tofranil). All of these medications have significant potential for side effects, should be reserved for a very select population, and should be used to treat the symptoms not as a cure, while awaiting natural resolution. Medications can be used intermittently for children who attend overnight camp or for sleepovers since these are 70% effective in preventing the symptoms, and bedwetting in these environments can be humiliating and stress-producing for children.

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