Urinary incontinence occurs in about 10% of 5 year olds and 5% of 10 year olds. Incontinence in children can occur at night (nocturnal enuresis), during the day, or both (diurnal incontinence).
Occasionally, structural abnormalities of the urinary tract cause urinary incontinence, but most commonly, abnormalities in voiding behavior, voiding dynamics, and/or bladder activity are responsible. In addition, constipation and dietary factors are frequent contributors to urinary incontinence in children.
Isolated nocturnal enuresis (bedwetting) is involuntary urination while asleep that occurs after the age at which bladder control normally develops (age 6-7). In most patients, bedwetting will resolve spontaneously by the age of 18 without treatment. In many patients, there is a strong family history of bedwetting, suggesting a genetic predisposition. Bedwetting is associated with multiple etiologic factors including sleep or arousal disorders, food sensitivities, high urine production, low functional bladder capacity , and constipation. Treatment for bedwetting includes dietary modification, nighttime fluid restriction, bedwetting alarm systems, and medication. Alarms can be purchased at Bedwetting Store.
Daytime incontinence is generally less common than isolated nighttime incontinence and is usually related to abnormal voiding habits (holding behavior), constipation, an overactive bladder, or bladder irritants in the diet (caffeine, carbonated beverages, citrus juice, artificial dyes). Daytime incontinence can also be associated with urinary tract infections, and occasionally, urinary tract abnormalities. Treatment is focused on patient education regarding normal voiding habits and techniques, the elimination of bladder irritants from the diet, and treatment of constipation. Some children may also require a medication to relax the bladder. In refractory or unusual cases, further diagnostic testing with urodynamics may be required. Children with dysfunctional or uncoordinated voiding (bladder contracts while the urinary sphincter is closed) may require neuromuscular re-education or biofeedback therapy. It is important that you fill out a voiding questionnaire for your child and bring that with you to your appointment.
Our pediatric continence center is directed by Lindsay Rohan, ARNP, who specializes in the diagnostic evaluation and treatment of these conditions.
Urodynamic testing is a procedure that examines the bladder’s ability to hold urine and empty effectively. It also examines bladder compliance and the presence of involuntary contractions. Urodynamic testing requires the placement of a catheter in the bladder and a small balloon in the rectum. Contrast is used to fill the bladder while the pressures inside the bladder are monitored. The patient is then asked to urinate. Pictures of the bladder are taken throughout the procedure. The procedure takes about 45 mintutes to complete and a urine culture will need to be obtained prior to the procedure. Please follow the instruction sheet provided so that your appointment runs smoothly.
Biofeedback is a treatment option available for the management of voiding dysfunction in children. This is a painless procedure used to accomplish pelvic floor muscle retraining. Biofeedback systems use monitoring devices and patch electrodes to obtain and relay visual/auditory cues on pelvic floor activity and bladder emptying to the child. This helps the child sense and respond appropriately to the body’s messages related to voiding activity.