Urinary Incontinence in Children

Urinary incontinence refers to the involuntary loss of urine and is also referred to as enuresis when specifically relating to children.

It is normal for young children to be unable to control when they urinate but when they reach the age of five they should be toilet trained and be able to control when they urinate. Therefore, urinary incontinence in children becomes an issue that requires further management from this age onwards.

Infant Urine Control and Toilet Training

Babies do not have any control over when they urinate and when their bladder fills to a specific point, the muscles contract automatically to void their bladder.

As their brain and nervous system grows and matures, the brain begins to recognize messages that indicate the bladder is almost full and sends signals to the bladder. This allows the child to hold the contractions until they can reach an appropriate place to urinate.

This usually happens at approximately two years old when the toddler is toilet trained, although can vary greatly from child to child.

Epidemiology

Young boys are more likely to have difficulty controlling urination and be incontinent than young girls. Urinary incontinence in children is separated into daytime and nighttime occurrences.

Approximately 17-20% of children experience symptoms during the day, with 1 in 20 of these also suffering from bedwetting during the night. Incontinence at nighttime alone has a prevalence of approximately 8-20% in children five years old and gradually becomes less prevalent with 15% children ceasing to suffer from the condition each year. Some individuals do not grow out of the condition and continue to lack bladder control during the nighttime until adulthood.

Psychological Impact

It is common for children affected by urinary incontinence to be significantly impacted psychologically, which can make a difference to their overall wellbeing and quality of life.

When children are beginning to interact socially with other children, the experiences they have make a lasting impression on their character. Incontinence can present embarrassing situations for children that shape their character.

As a result, it is imperative that children over the age of five with urinary incontinence be managed appropriately. Assessment of the condition should be made to identify possible causes and interventions that could offer a benefit. Successful treatment can make a significant difference in the symptoms of the condition and psychosocial wellbeing of the child.

Causes

There are several possible causes of enuresis including:

• Anxiety
• Attention Deficit/Hyperactivity Disorder (ADHD)
• Caffeine
• Constipation
• Undiagnosed diabetes
• Hormonal imbalances
• Overactive bladder
• Delayed mental development
• Small bladder
• Anatomical abnormalities of urinary tract
• Urinary tract infection

Where possible, potential cause should be identified to assist in the management of the condition.

Non-pharmacological therapy

In most cases, management should begin without the use of medications, as it is likely the child will outgrow the problem with the appropriate care.

Initially, behavioral changes should be made, such as limiting fluid intake particularly at problematic times of the day (e.g. before bed). Caffeine is a known diuretic and increases the frequency of urination; beverages that contain caffeine such as cola and other carbonated drinks should be avoided.

For children that suffer from symptoms during the night and bedwetting, there may be a benefit to waking them midway through the night to take them to the toilet. Additionally, a moisture alarm that is set to sound when it detects urine can help to wake the child when close to urination.

If symptoms during the day pose a greater problem, bladder training techniques may be beneficial. This includes exercises and a schedule to urinate that help to create a routine and form good urination habits.

Counseling for the child may also be useful to help work through any related stress or life changes that may be impacting ability to remain continent.

Pharmacological therapy

Medications are often needed in the management of other underlying health conditions, such as ADHD and constipation, to improve symptoms of incontinence.

If an overactive bladder is likely to be problematic, anticholinergic drugs may help to inhibit the contraction of the detrusor muscle of the bladder and related incontinence.

References

• http://www.niddk.nih.gov/health-information/health-topics/urologic-disease/urinary-incontinence-in-children/Pages/facts.aspx
• http://www.kidneyurology.org/Library/Urologic_Health.php/Urinary_Incontinence_Children.php
• http://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=90&ContentID=P03083
• http://www.australianprescriber.com/magazine/37/6/192/5