Urinary Incontinence in Children
Urinary Incontinence
Recurrent urinary incontinence, day or night, in children is called Enuresis nocturna (EN). Also known as bedwetting at night. It is one of the most common urinary system (excretory system) problems of childhood.
Normally, most children are able to hold their urine both day and night between the ages of 2-4 as a result of both the effect of toilet training and the development of bladder capacity. Bedwetting at night is often the result of delayed bladder development, so its frequency decreases with age.
Although 40% of three-year-olds wet the bed, this rate drops to 20% at the age of 5 and 10% at the age of 6. Boys have more frequent bedwetting problems than girls. Families begin to deal with this problem around the age of 5-6 and usually seek help from physicians at the age of 7-8. It is reported that 16% of 7-11 year old boys and 11% of girls have bedwetting problems.
The causes of urinary incontinence can be physiological or emotional. If the problem is not resolved with changes such as limiting fluid intake and avoiding carbonated drinks, you should seek expert support for other underlying causes. Urinary tract infections, chronic constipation, sleep problems or excessive stress can cause this condition.
Enuresis can occur during the day or at night. While it can be worrying for parents, it’s important to be patient and remember that it’s not your child’s fault. The child does not consciously leak urine, and there are many ways to prevent this situation.
Reasons
A large group (90-95%) of children who wet the bed at night are gathered in the physiological bedwetting group. It is reported that these children have insufficient feeling of bladder fullness during sleep at night, their bladder capacity is small and their sleep depth is high. Problems such as diabetes, kidney diseases and bladder diseases are detected in 2-3% of children who wet the bed.
Genetic causes are an important factor. If one of the parents has a history of bedwetting, the child has a 45% problem, and if both parents have a history of bedwetting, it is 77%.
One or More of the Following Causes Could Cause This Condition
Having a urinary incontinence problem in the mother or father
The child’s bladder muscles are not yet mature
Excessive tiredness or drinking too much before bed
Structural problems in the kidney and urinary tract
Stress and anxiety problems (Family problems, changing home or school, new sibling joining the family, or wanting attention due to sibling jealousy)
Emotional problems (Parent’s indifference or excessive attention, accidents or shocks)
Pressure during toilet training
Attention deficit and hyperactivity disorder (ADHD)
Constipation putting pressure on the bladder
Diabetes
Insufficient secretion of antidiuretic hormone (ADH) during sleep
obstructive sleep apnea syndrome
overactive bladder syndrome
small bladder
Inability to feel that the bladder is full while asleep
urinary tract infections
The Following Reasons Should Be Considered in Daytime Urinary Incontinence
Stress and anxiety issues
Caffeinated drinks such as cola
Constipation putting pressure on the bladder
Not going to the toilet often enough
Not urinating all while peeing
Overactive bladder syndrome
Small bladder
Structural problems in the urinary tract
Urinary tract infections
Urinary incontinence can be seen more frequently in children with constipation, who do not have the habit of going to the toilet regularly, who have differences in physical development and who have anxiety problems.
Due to the stressful situation caused by urinary incontinence, enuresis-related psychological problems such as anxiety and self-confidence also occur. Getting expert support when necessary will positively affect your child’s physiological and mental health.
Symptoms
Urinary incontinence itself can be a symptom of different diseases rather than a disease. Therefore, if your child has such a complaint, it is important to consult your doctor in order to evaluate the underlying causes.
Diagnostic Methods
Urinary incontinence occurs in the vast majority of children. This is because some children take longer to learn bladder control. Girls have bladder control earlier than boys. Therefore, enuresis is more common in boys.
For diagnosis, your doctor will seek answers to the following questions:
Voiding habits
Defecation habits
Fluid intake habits
Sleep features
Psychological status (Are there any recent stressful situations?)
Family history of urinary incontinence
Pain or burning when urinating
Having constipation problem
To determine the child’s voiding habit, it should be recorded using a chart and shared with the doctor.
A physical examination, blood and urine tests may also be done. In the tests, the presence of urinary tract infection or diabetes is investigated.
For children who wet the bed during the day, uroflowmetry, cystetrogram, ultrasonography, measurement of bladder wall thickness and measurement of residual urine after voiding may be required. If a neurological cause is suspected, X-ray and MRI can be done.
Treatment Methods
The first treatment for urinary incontinence is usually to change daily habits. In order to do this, it is necessary to avoid behaviors such as putting pressure on the child, being excessively meticulous, blaming or scolding, and being supportive. Besides these;
Reducing the amount of fluid taken at certain times of the day and at night,
Especially not giving water 2 hours before going to bed,
Avoiding caffeinated foods and drinks
Going to the toilet before going to bed
Facilitating access to the toilet
Waking your child to urinate at night on a certain schedule,
Avoiding fried foods, carbonated drinks, dyed candies,
Urinating every two hours on average,
Children who go to school must pee every two breaks,
Performing regular defecation every day,
The child’s toilet must be seated (alafranga) and a suitable step is placed under his feet.
Encouraging the child to take responsibility for staying dry
Behavioral changes, such as supporting the child’s self-esteem, may also be recommended by your doctor.
Alarm therapy or drug therapy can be started in children who do not benefit from behavioral and lifestyle changes.
In alarm therapy, devices that ring when the child wets the bed are used. For this, the child should be expected to complete 8 years of age and the treatment should be continued for 2-3 months. With this treatment, 70-84% improvement is achieved in children. At the end of alarm treatment, the risk of recurrence is around 10%.
The aim of drug therapy is to prevent involuntary bladder contraction and to enlarge the bladder. Medication may take an average of 1 year or more. Common side effects from medications include dry mouth, blurred vision, flushing, fever, irritability, and decreased school performance.
If urinary incontinence is due to causes such as constipation, urinary tract infections, these problems should be treated first.
Therapy (counselling): Working with a child psychiatrist can help your child cope with life changes or other stresses.
How Can You Help Your Child?
Children may feel ashamed or guilty about bedwetting and may be anxious. Remember that your child does not consciously wet the bed and cannot prevent it without your help. Don’t scold or blame him. Make sure she isn’t made to feel bad by her friends or other family members because of it.
Remember that enuresis is a temporary problem. Carry additional clothing with you when you go out for daytime incontinence.
"The content of the page is for informational purposes only. Consult your doctor for diagnosis and treatment."
