Children who experience bedwetting at night or accidents during the day should treat this problem with understanding and patience. This loss of urinary control is called urinary incontinence or just incontinence. Although it affects many young people, it usually disappears naturally over time, which suggests that incontinence, for some people, may be a normal part of growing up. Incontinence at the normal age of toilet training may cause great distress. Daytime or nighttime incontinence can be embarrassing. It is important to understand that many children experience occasional incontinence and that treatment is available for most children who have difficulty controlling their bladders.

How does the urinary system work?

Urination, or voiding, is a complex activity. The bladder is a balloon-like muscle that lies in the lowest part of the abdomen. The bladder stores urine, then releases it through the urethra, the canal that carries urine to the outside of the body. Controlling this activity involves nerves, muscles, the spinal cord, and the brain.

The bladder is made of two types of muscles: the detrusor, a muscular sac that stores urine and squeezes to empty, and the sphincter, a circular group of muscles at the bottom or neck of the bladder that automatically stay contracted to hold the urine in and automatically relax when the detrusor contracts to let the urine into the urethra. A third group of muscles below the bladder (pelvic floor muscles) can contract to keep urine back.

A baby’s bladder fills to a set point, then automatically contracts and empties. As the child gets older, the nervous system develops. The child’s brain begins to get messages from the filling bladder and begins to send messages to the bladder to keep it from automatically emptying until the child decides it is the time and place to void.

Failures in this control mechanism result in incontinence. Reasons for this failure range from the simple to the complex.

Incontinence happens less often after age 5. About 10 percent of 5-year-olds, 5 percent of 10-year-olds, and 1 percent of 18-year-olds experience episodes of incontinence. It is twice as common in boys as in girls.

Causes of nighttime incontinence

After age 5, wetting at night–often called bedwetting or sleepwetting–is more common than daytime wetting in boys. Experts do not know what causes nighttime incontinence. Young people who experience nighttime wetting tend to be physically and emotionally normal. Most cases probably result from a mix of factors including slower physical development, an overproduction of urine at night, a lack of ability to recognize bladder filling when asleep, and, in some cases, anxiety. For many, there is a strong family history of bedwetting, suggesting an inherited factor.

Causes of daytime incontinence

Daytime incontinence that is not associated with urinary infection or anatomic abnormalities is less common than nighttime incontinence and tends to disappear much earlier than the nighttime versions. One possible cause of daytime incontinence is an overactive bladder. Many children with daytime incontinence have abnormal voiding habits, the most common being infrequent voiding. This form of incontinence occurs more often in girls than in boys.

Other causes

Some of the same factors that contribute to nighttime incontinence may act together with infrequent voiding to produce daytime incontinence. These factors include

  • a small bladder capacity
  • structural problems
  • anxiety-causing events
  • pressure from a hard bowel movement (constipation)
  • drinks or foods that contain caffeine, which increases urine output and may also cause spasms of the bladder muscle, or other ingredients to which the child may have an allergic reaction, such as chocolate or artificial coloring

Sometimes overly strenuous toilet training may make the child unable to relax the sphincter and the pelvic floor to completely empty the bladder. Retaining urine (incomplete emptying) sets the stage for urinary tract infections.

Bladder training and related strategies

Bladder training consists of exercises for strengthening and coordinating muscles of the bladder and urethra, and may help the control of urination. These techniques teach the child to anticipate the need to urinate and prevent urination when away from a toilet. Techniques that may help nighttime incontinence include

  • determining bladder capacity
  • stretching the bladder (delaying urinating)
  • drinking less fluid before sleeping
  • developing routines for waking up

Unfortunately, none of the above has demonstrated proven success.

Techniques that may help daytime incontinence include

  • urinating on a schedule, such as every 2 hours (this is called timed voiding)
  • avoiding caffeine or other foods or drinks that may contribute to a child’s incontinence
  • following suggestions for healthy urination, such as relaxing muscles and taking your time

Diagnosis

Sometimes doctors can diagnose the cause by the child’s symptoms and the results of an examination. To check for an infection, a urinalysis and sometimes a urine culture is done. To check for diabetes mellitus and diabetes insipidus, doctors use blood and urine tests to check sugar and electrolyte levels. If a birth defect is suspected, an ultrasound examination of the kidneys and bladder and x-rays of the spine may be necessary. A special x-ray of the bladder and kidneys, called a voiding cystourethrogram, may also be necessary. With this test, a dye is injected into the bladder using a catheter, which shows the anatomy of the urinary tract, as well as the direction of urine flow.

Points to remember about urinary incontinence In children

  • Urinary incontinence in children is common.
  • Nighttime wetting occurs more commonly in boys.
  • Daytime wetting is more common in girls.
  • After age 5, incontinence disappears naturally at a rate of 15 percent of cases per year.
  • Treatments include waiting, dietary modification, moisture alarms, medications, and bladder training.

Sources: Health link, Medicine Net

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