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Urinary Incontinence In Child Treatment

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What Causes Overactive Bladder In Children

Voiding Dysfunction Urinary Incontinence in Children | Dr. Amrish Vaidya

Children with overactive bladders have a need to urinate more often than usual because their bladder muscles have uncontrollable spasms. The muscles surrounding the urethra — the tube from the bladder that urine passes through — can be affected. These muscles are meant to prevent urine from leaving the body, but they may be “overridden” if the bladder undergoes a strong contraction.

Urinary tract infections can cause a need to urinate as the urinary tract becomes inflamed and uncomfortable. Certain neurological conditions may cause these symptoms.

Another cause of overactive bladder is a condition called pollakiuria, or frequent daytime urination syndrome. Children who have pollakiuria urinate frequently. In some cases, they may urinate every five to 10 minutes or urinate between 10 and 30 times a day. This condition is most common among children aged 3 to 8 and is present only during waking hours. There are no other symptoms present. Doctors believe that pollakiuria is related to stress. Usually, the condition goes away after two to three weeks without requiring treatment.

Other causes of overactive bladder in children include:

  • consumption of caffeine, which increases urine output and can cause spasms in the bladder muscle
  • consumption of ingredients that a child may be allergic to
  • events that cause anxiety
  • refraining from completely emptying the bladder when on the toilet
  • obstructive slep apnea

How Common Is Urinary Incontinence In Children

Studies indicate that 20% of all 5-year-old children and 10% of 7-year-olds wet the bed, and of these, up to 20% also have some degree of daytime incontinence. In addition, nocturnal enuresis is more common in boys, and diurnal incontinence is more common in girls. Secondary enuresis accounts for about one-quarter of all cases and is most often associated with some psychological stressor or anxiety.

What Causes Nighttime Incontinence

After age 5, wetting at night — often called bedwetting or sleepwetting — is more common than daytime wetting. Experts do not know what causes nighttime incontinence. Young people who experience nighttime wetting are usually 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, infrequently, anxiety. For many, there is a strong family history of bedwetting, suggesting an inherited factor.

Slower Physical Development

Between the ages of 5 and 10, bedwetting may be the result of a small bladder capacity, long sleeping periods, and underdevelopment of the body’s alarms that signal a full or emptying bladder. This form of incontinence will fade away as the bladder grows and the natural alarms become operational.

Excessive Output of Urine During Sleep

Normally, the body produces a hormone that can slow the production of urine. This hormone is called antidiuretic hormone, or ADH. The body normally produces more ADH at night so that the need to urinate is lower. If the body doesn’t produce enough ADH at night, the production of urine may not be slowed down, leading to bladder overfilling. If a child does not sense the bladder filling and awaken to urinate, then wetting will occur.



Obstructive Sleep Apnea

Structural Problems

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What Causes 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 elimination habits, the most common being infrequent voiding and constipation.

An Overactive Bladder

Muscles surrounding the urethra — the tube that takes urine away from the bladder — have the job of keeping the passage closed, preventing urine from passing out of the body. If the bladder contracts strongly and without warning, the muscles surrounding the urethra may not be able to keep urine from passing. This often happens as a consequence of urinary tract infection and is more common in girls.

Infrequent Voiding

Infrequent voiding refers to a child’s voluntarily holding urine for prolonged intervals. For example, a child may not want to use the toilets at school or may not want to interrupt enjoyable activities, so he or she ignores the body’s signal of a full bladder. In these cases, the bladder can overfill and leak urine. In addition, these children often develop UTIs, leading to an irritable or overactive bladder.

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

Key Points About Enuresis In Children

Why do children miss urine? Causes Treatment
  • Urinary incontinence is the loss of bladder control. In children under age 3, its normal to not have full bladder control. As children get older, they become more able to control their bladder.

  • It can happen during the day or at night.

  • It has many possible causes. These include anxiety, constipation, genes, and caffeine.

  • In many cases, it goes away over time and does not need to be treated.

  • If treatment is needed, many methods can help. These include changes in fluid intake, reducing caffeine, and urinating on a schedule.

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When To Seek Medical Advice

See a GP if you have any type of urinary incontinence. Urinary incontinence is a common problem and you should not feel embarrassed talking to them about your symptoms.

This can also be the first step towards finding a way to effectively manage the problem.

Urinary incontinence can usually be diagnosed after a consultation with a GP, who will ask about your symptoms and may do a pelvic or rectal examination, depending on whether you have a vagina or a penis.

The GP may also suggest you keep a diary in which you note how much fluid you drink and how often you have to urinate.

Find out about diagnosing urinary incontinence.

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Coimbatore, Tamil Nadu, India Business Wire India Today, every 1 in 3 women is dealing with urinary incontinence. Yet only a brief percent of women are getting treated. Here’s what one needs to know about the condition and why getting treated right on time is important. The Department of Uro-Gynecology at Sri Ramakrishna Hospital provides an in-depth look into urinary incontinence and the signs to look for to make an early diagnosis.

Back in the day, urinary incontinence was affected in older women and was quite rare among the young. But due to the fast pace of life and drastic changes in lifestyle now, young women are also facing this issue.

Statistics show that about 21.3% of the whole population is affected by urinary incontinence. But what exactly is this condition? Understanding urinary incontinence: Urinary incontinence is referred to as an abrupt loss of urine involuntarily. It is due to the loss of bladder control that is quite common in older women and women who have given birth. Other causes include uterine prolapse and recurrent urinary tract infections. There are a few types of urinary incontinence that can include: Urge incontinence: This sort of incontinence is distinguished by an urgent need to urinate.

Often, this occurs too quickly for one to reach a toilet, resulting in urine leakage.

Urge incontinence may result from a condition known as overactive bladder .

Think of the bladder as a juice container.


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Causes Of Urinary Incontinence In Children

The pattern of incontinence helps the doctor determine the likely cause. If the child has never had a consistent dry period during the day, the doctor may consider the possibility of a birth defect, an anatomic abnormality, or certain behaviors that can lead to incontinence.

Several uncommon but important disorders affect the normal anatomy or function of the bladder, which can lead to urinary incontinence. For example, a spinal cord defect such as spina bifida Neural Tube Defects and Spina Bifida Neural tube defects are a certain type of birth defect of the brain, spine, and/or spinal cord. Neural tube defects can result in nerve damage, learning disabilities, paralysis, and death. The… read more can cause abnormal nerve function to the bladder and lead to incontinence. Some infants have a birth defect that prevents the bladder or urethra from developing completely, leading to nearly constant urine loss . Another type of birth defect causes the tubes that connect the kidneys to the bladder to end in an abnormal location in the bladder or even outside the bladder , causing incontinence to the bladder . People… read more ). Some children have an overactive bladder that easily spasms or contracts, causing incontinence, whereas others may have difficulty emptying their bladder.

Is Bedwetting Related To Overactive Bladder In Children

Day/Nighttime Urinary Incontinence to Children

Yes. Some of the same conditions or circumstances that increase the likelihood of nighttime incontinence may — in combination with infrequent urination — result in incontinence during the day. These conditions and circumstances include pressure from a hard bowel movement or other causes listed above.

Another cause of nighttime incontinence is related to the antidiuretic hormone , which the body produces to slow urine production. Children tend to produce more ADH at night, so there is less need to urinate. If the body does not produce enough ADH, the production of urine may not slow and the bladder may overfill, leading to bedwetting.

Some other potential causes of bedwetting include:

  • Family history
  • Stress and life changes like a new sibling, changes in living circumstances
  • Sleep disruptions
  • Type 1 Diabetes- also causes increase thirst and urination

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What Are Urodynamic Investigations

A catheter is placed in the rectum at the time for the duration of the study and all tubes are removed on completion of the test. This test may be combined with x-ray imaging and is usually carried out in the x-ray department. The test takes an hour and a half to two hours and is very useful in selected cases in getting to the bottom of the cause of urinary incontinence and planning treatment.

Diagnosing Urinary Incontinence In Children

Persistent urinary incontinence beyond five years of age requires medical investigation. A good medical history and physical examination followed by some baseline investigations are a good starting point and will usually allow for a distinction to be made between primarily bedwetting at night and children with associated daytime symptoms. As continuous urinary incontinence is usually the result of some congenital malformation it should be investigated and treated as early as possible. The physical examination will usually not show anything remarkable in these children however a small minority may have some subtle findings that can be responsible for the symptoms and therefore must be excluded in all cases.

An ultrasound scan can also be performed that will screen the kidneys looking for any abnormality such as hydronephrosis, which is where the kidneys become swollen due to urine building up inside them, and which is usually suggestive of a congenital malformation as the cause of incontinence. An ultrasound scan will also provide information regarding bladder capacity and efficiency at emptying and can occasionally pick up vaginal reflux if this is present. Following a review of these baseline investigations the child may be referred for more targeted urodynamic investigations.

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Nocturnal Urinary Incontinence In Children

It is a symptom of involuntary urination during sleep and affects those over the age of five. It is also called mono symptomatic incontinence, meaning bed-wetting during sleep at night, and the main causes of nocturnal urinary incontinence in these children are the hyperactive bladder due to its smallness or due to a lack of production the pituitary gland of the antidiuretic hormone in the brain.

How Is Enuresis Diagnosed

Causes of Incontinence

Your childs health care provider will ask about your childs medical history. Make sure to tell the health care provider:

  • If other members of the family have had enuresis

  • How often your child urinates during the day

  • How much your child drinks in the evening

  • If your child has symptoms such as pain or burning when urinating

  • If the urine is dark or cloudy or has blood in it

  • If your child is constipated

  • If your child has had recent stress in his or her life

The health care provider may give your child a physical exam. Your child may also need tests, such as urine tests or blood tests. These are done to look for a medical problem, such as an infection or diabetes.

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Should You See A Doctor About Urinary Incontinence In Children

You should see your GP for advice about treatment and management if your child is older than five years and:

  • is experiencing urinary incontinence more than once a month
  • has never had a period of dryness.

When you see the GP, the GP might start by doing a physical examination of your childs tummy, lower back and genitals. The GP might also test your childs urine.

The GP might refer your child to a continence nurse or medical specialist.

Treatment Of Urinary Incontinence In Children

When does medical intervention become necessary for the treatment of urinary incontinence in children, and when may the problem be treated at home?

Diaper-free training often begins at age but can begin earlier or later depending on the child’s response and the mother’s level of preparedness. Involuntary urination is a concern for parents when their child has been diaper-free for a significant amount of time but suddenly starts to have urinary incontinence after this stage.

Below, we will discuss the treatment of involuntary urination in children in further detail and note that the issue of enuresis in children at night is not essential if the child is still under 5-6 years of age.

Five-year-old children had an incidence of involuntary urination between 15-20%, seven-year-olds at 7%, and ten-year-olds at 5%. Approximately 2% to 3% of adolescents experience episodes of uncontrollable urinating.

Types of children’s urinary incontinence

  • Daytime urinary incontinence is the occurrence of daytime dampness.
  • Nighttime urinary incontinence: is the most common type of involuntary urine in children. When wetness occurs during sleep, it is known as clinical wetness.
  • Primary involuntary urination: This type of enuresis happens throughout periods of learning to remove diapers in children younger than 7 years of age.
  • Secondary involuntary urination: This type occurs after the total elimination of diapers in children older than 7 years.
  • ADHD children.
  • How old is the child?
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    What Treats Or Cures Incontinence

    Growth and Development

    Most urinary incontinence fades away naturally. Here are examples of what can happen over time:

    • Bladder capacity increases.
    • Natural body alarms become activated.
    • An overactive bladder settles down.
    • Production of ADH becomes normal.
    • The child learns to respond to the body’s signal that it is time to void.
    • Stressful events or periods pass.

    Many children overcome incontinence naturally — without treatment — as they grow older. The number of cases of incontinence goes down by 15 percent for each year after the age of 5.


    Nighttime incontinence may be treated by increasing ADH levels. The hormone can be boosted by a synthetic version known as desmopressin, or DDAVP, which is available in pill form, nasal spray, or nose drops. Desmopressin is approved for use in children.

    Another medication, called imipramine, is also used to treat sleepwetting. It acts on both the brain and the urinary bladder. Researchers estimate that these medications may help as many as 70 percent of patients achieve short-term success. Many patients, however, relapse once the medication is withdrawn.

    If a young person experiences incontinence resulting from an overactive bladder, a doctor might prescribe a medicine that helps to calm the bladder muscle. This medicine controls muscle spasms and belongs to a class of medications called anticholinergics.

    Bladder Training and Related Strategies

    Unfortunately, none of these techniques guarantees success.

    Moisture Alarms

    What Is Pediatric Incontinence

    What is urinary incontinence? Causes, symptoms and treatment explained

    Heres how urination normally works for children and adults, too. The bladder, a small balloon-shaped organ receives and stores urine produced by the kidneys. The bladder muscles remain relaxed while the bladder fills with urine. Then when its convenient, the bladder contracts and empties through the urethrawhere sphincters and pelvic floor muscles loosen to allow the urine pass and tighten afterwards to stop it.

    But when children have urinary incontinence, they involuntary release urine even after being toiled-trained. It may occur during the day or night. Most children are potty-trained by age 5, and those who arent fully trained by then or who continue to have accidents may have an underlying medical condition or other issue that is causing the problem. If a child between the ages of 5 and 18 has two or more wetting episodes a month, he or she may benefit from treatment to gain bladder control.

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    How Do You Differentiate Between Organic And Nonorganic Causes Of Urinary Incontinence

    It is important to recognize that most cases of urinary incontinence are caused by nonorganic problems, but since there are organic causes, physicians may evaluate affected children with some basic studies. Evaluation always begins with a complete history and physical exam. This differentiates between the otherwise healthy child and the child with underlying disease. The clinician will probably ask about psychological stressors, such as starting a new school, the birth of a sibling, or parental strife. In addition, in order to evaluate the severity of the symptoms, parents will be encouraged to keep a voiding diary. These are diaries which document the number of daytime voids, volumes, timing, and relationship with eating and drinking. In addition, these diaries should document the frequency of daytime wetting or nighttime wetting. Besides the history, physical, and diary, a urinalysis can be helpful to screen for organic causes, such as diabetes and urinary tract infections. For children with significant daytime symptoms, ultrasound imaging of the urinary tract including bladder and kidneys may be needed to evaluate for anatomic abnormalities. Lastly and rarely, if a neurological cause is suspected, an MRI of the spine may be indicated to evaluate for spinal cord abnormalities.

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