Enuresis (Incontinence in Children)
Enuresis at a glance
- Enuresis or urinary incontinence in children is defined as a problem controlling the bladder when a child is past the age of toilet training.
- Bladder control problems are very common in children, especially if one of the parents had bedwetting issues.
- Pediatric incontinence often resolves itself as a child ages and it rarely leads to issues as an adulthood.
- At times medication or surgery is needed to treat the underlying cause of incontinence in children.
What is incontinence in children?
Urinary incontinence in children, also known as enuresis, is the loss of complete urinary control or involuntary urination two or more times per month. Symptoms include leaking urine, frequent or urgent trips to the bathroom, and/or wetting the bed.
Due to of the duration of the toilet training process, children are usually not considered to have incontinence until they are of an age to control their bladder. Typically, this is after the age of 5 (during the day) or the age of 7 (at night).
Incontinence occurring during the day is known as diurnal enuresis or daytime incontinence. Incontinence occurring at night is known as nocturnal enuresis or bedwetting. While children can experience both day and night incontinence, girls are more common to have daytime enuresis while boys are more likely to have nocturnal enuresis.
Bedwetting is very common and tends to run in families. It affects around 30 percent of children at age 4, 10 percent at age 7, 3 percent at age 12, and 1 percent of people at age 18 report still wetting the bed.
Causes of pediatric incontinence
Bladder control problems can stem from a variety of issues, some physical and some from poor bathroom habits, such as holding urine too long before urination.
Diet also plays a role in bladder control problems. When it comes to beverages, children should avoid caffeine and carbonated, citrus and sports drinks. They all can irritate the bladder or cause excess urine.
Factors contributing to daytime and nighttime incontinence can differ, and are outlined below.
Causes of daytime urinary incontinence in children
Daytime incontinence is commonly caused by holding urine too long, but other possible factors include:
- Bladder or kidney irritation including urinary tract infections (UTI)
- Structural problems in the urinary tract
- Nerve or muscle problems preventing the bladder from holding urine
- Overactive or underactive bladder
Causes of nighttime bedwetting in children
Children with nighttime wetting often have different conditions causing the problem compared with those who are affected during the day. Possible causes for bedwetting include:
- Family history
- Slow physical development
- Making too much urine
- Sleep disorder – sleepwalking or obstructive sleep apnea (OSA)
- Attention-deficit/hyperactivity disorder (ADHD)
When to see a doctor for enuresis
Incontinence in children most often resolves itself without medical intervention but in some cases requires medical treatment to avoid damage to the kidneys or bladder.
If the child presents any of the following bladder infection symptoms, it is time to seek medical attention:
- Burning or pain while urinating
- Pain in the lower back or belly area
- Crying while urinating
- Bloody, dark, cloudy or foul-smelling urine
- Urinating more often than usual
- Strong urges to urinate with only a small amount of urine flow
Other reasons to take children to the doctor are if they have a weak urine stream or only dribble while urinating. This can be a sign of a birth defect in the urinary tract.
Alternatively, if a child was dry for more than six months and then started having wetting problems, this is also something to discuss with a doctor.
Bladder control problems are diagnosed by looking at medical history, completing a physical exam, lab tests and possibly imaging tests. In some instances, the child will also be asked to urinate into a machine that checks the amount and speed of urine produced.
Parents should be aware of their family history, their child’s symptoms, dry periods, frequency and when the wetting happens. Prior to an office visit, it might be helpful to use a bladder diary to track the child’s bathroom habits and the amount of liquid he or she is drinking.
Enuresis treatment options
Treating enuresis depends on the underlying cause of the urinary problem and the severity of the symptoms. It’s important for a doctor to work with the child and the family to find the best treatment option for each patient. This may include one or a combination of the following common treatment methods:
- Eliminating bladder irritants
- Taking medication to limit daytime wetting or to treat UTIs
- Behavioral interventions to gain control over the bladder and reinforce healthy habits.
Helping children cope with incontinence problems
Parental understanding, encouragement and patience are vital to helping a child cope with bladder control problems. If parents suspect there is a chance of a health problem causing the child’s incontinence, they should make an appointment with a doctor.
For children with daytime incontinence, consider a wristwatch with an alarm set to vibrate to remind the child to visit the bathroom. If a child wets the bed, be sure to have a waterproof pad on the bed and have dry pajamas and towels available for easy cleanup.
It is recommended to stop using diapers or disposable training pants, except when away from the home. While these aids are helpful for cleanup, they discourage the child from getting out of bed to use the toilet.
It is important the child knows that bedwetting and daytime incontinences are common, and most children grow out of it. If the child is over 4 years old, ask for his or her ideas on how to manage the problem. Involving the child in finding the solution can provide a sense of control.