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Urinary Incontinence In Children Fact Book
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In the United States, at least 13 million people have problems holding
urine until they can get to a toilet. 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. No matter when it happens or how often it happens,
incontinence causes great distress. It may get in the way of a good
night's sleep and is embarrassing when it happens during the day. That's
why it is important to understand that occasional incontinence is a normal
part of growing up and that treatment is available for most children who
have difficulty controlling their bladders.
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How Does the Urinary System Work?
Urination, or voiding, is a complex activity. The bladder is a
balloonlike 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.
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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. |
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What Causes 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.
Slower Physical Development
Between the ages of 5 and 10, incontinence 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 making 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 making 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.
Anxiety
Experts suggest that anxiety-causing events occurring in the lives of
children ages 2 to 4 might lead to incontinence before the child achieves
total bladder control. Anxiety experienced after age 4 might lead to
wetting after the child has been dry for a period of 6 months or more.
Such events include angry parents, unfamiliar social situations, and
overwhelming family events such as the birth of a brother or sister.
Incontinence itself is an anxiety-causing event. Strong bladder
contractions leading to leakage in the daytime can cause embarrassment and
anxiety that lead to wetting at night.
Genetics
Certain inherited genes appear to contribute to incontinence. In 1995,
Danish researchers announced they had found a site on human chromosome 13
that is responsible, at least in part, for nighttime wetting. If both
parents were bedwetters, a child has an 80 percent chance of being a
bedwetter also. Experts believe that other, undetermined genes also may be
involved in incontinence.
Obstructive Sleep Apnea
Nighttime incontinence may be one sign of another condition called
obstructive sleep apnea, in which the child's breathing is interrupted
during sleep, often because of inflamed or enlarged tonsils or adenoids.
Other symptoms of this condition include snoring, mouth breathing,
frequent ear and sinus infections, sore throat, choking, and daytime
drowsiness. In some cases, successful treatment of this breathing disorder
may also resolve the associated nighttime incontinence.
Structural Problems
Finally, a small number of cases of incontinence are caused by physical
problems in the urinary system in children. Rarely, a blocked bladder or
urethra may cause the bladder to overfill and leak. Nerve damage
associated with the birth defect spina bifida can cause incontinence. In
these cases, the incontinence can appear as a constant dribbling of
urine.
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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 voiding habits, the most common being
infrequent voiding.
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. Additionally, these children often develop
urinary tract infections (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
- 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.
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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.
Medications
Nighttime incontinence may be treated by increasing ADH levels. The
hormone can be boosted by a synthetic version known as desmopressin, or
DDAVP, which recently became available in pill form. Patients can also
spray a mist containing desmopressin into their nostrils. Desmopressin is
approved for use by children.
Another medication, called imipramine, is also used to treat
sleepwetting. It acts on both the brain and the urinary bladder.
Unfortunately, total dryness with either of the medications available is
achieved in only about 20 percent of patients.
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
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 you suspect may
contribute to your child's incontinence
- following suggestions for healthy urination, such as relaxing
muscles and taking your time
Moisture Alarms
At night, moisture alarms can awaken a person when he or she begins to
urinate. These devices include a water-sensitive pad worn in pajamas, a
wire connecting to a battery-driven control, and an alarm that sounds when
moisture is first detected. For the alarm to be effective, the child must
awaken or be awakened as soon as the alarm goes off. This may require
having another person sleep in the same room to awaken the bedwetter.
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Incontinence is also called enuresis
- Primary enuresis refers to wetting in a person who has never
been dry for at least 6 months.
- Secondary enuresis refers to wetting that begins after at
least 6 months of dryness.
- Nocturnal enuresis refers to wetting that usually occurs
during sleep (nighttime incontinence).
- Diurnal enuresis refers to wetting when awake (daytime
incontinence).
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Points to Remember
- 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.
Keeping on Top of Your Condition
Keeping in tune with your disease or condition not only makes treatment less intimidating but also increases its chance of success, and has been shown to lower a patients risk of complications. As well, as an informed patient, you are better able to discuss your condition and treatment options with your physician.
A new service available to patients provides a convenient means of staying informed, and ensures that the information is both reliable and accurate. If you wish to find out more about HealthNewsflash's innovative service, take the tour.
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Additional Resources
American Foundation for Urologic Disease
1128 North Charles
Street
Baltimore, MD 21201
Phone: 1-800-242-2383 or (410)
468-9235
Email: admin@afud.org
Internet: http://www.afud.org/
(Responds to
written requests for patient information)
National Association for Continence
P.O. Box
8310
Spartanburg, SC 29305
Phone: 1-800-BLADDER or (864)
579-7900
Email: memberservices@nafc.org
Internet:
http://www.nafc.org/
National Kidney Foundation, Inc.
30 East 33rd Street
New
York, NY 10016
Phone: 1-800-622-9010 or (212) 889-2210
Email: info@kidney.org
Internet: http://www.kidney.org/
The Simon Foundation for Continence
P.O. Box 835
Wilmette,
IL 60091
Phone: 1-800-23-SIMON or (847) 864-3913
Email: simoninfo@simonfoundation.org
Internet:
http://www.simonfoundation.org/
Society of Urologic Nurses and Associates
P.O. Box 56
East
Holly Avenue
Pitman, NJ 08071
Phone: 1-888-TAP-SUNA or (856)
256-2335
Email: suna@ajj.com
Internet: http://www.suna.org/ |
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