Urinary incontinence in children

Causes of bedwetting After age 5, nocturnal incontinence, often called enuresis or bedwetting, is more common in boys . Experts don't know what causes nocturnal incontinence. Young people who experience bedwetting generally tend to be physically and emotionally normal. Most cases probably result from a combination of factors, including slower physical development, overproduction of urine during the night, a lack of ability to recognize bladder filling during sleep, and, in some cases, anxiety. For many, there is a strong family history of enuresis, suggesting a hereditary factor. Slower physical development Aged between 5 and 10, incontinence can be the result of: of a small capacity bladder long periods of sleep and underdevelopment of the body's alarm signals that signal a full and empty bladder. Excessive urine production during sleep Normally, the body produces a hormone that can slow urine output. This hormone is called antidiuretic hormone, or ADH. The body normally produces more ADH during sleep so the need to urinate is less. If the body does not produce enough ADH during the night, urine production cannot be slowed, leading to the bladder "overflowing." If a child has not yet learned the signals to fill their bladder, they will wet the bed. Anxiety Experts suggest that anxiety caused by life events in children between the ages of 2 and 4 could lead to incontinence before children achieve full bladder control. Anxiety experienced after age 4 could lead to bedwetting even after the child has been dry for 6 months or more. These events include: Arguments between parents, Complicated social situations and major family events, such as the birth of a brother or sister. Incontinence is itself an anxiety-provoking event. Severe bladder contractions can lead to leaks throughout the day and cause embarrassment and worry. Genetics Certain inherited genes appear to contribute to incontinence. In 1995, Danish researchers announced they had found a marker on human chromosome 13 that is responsible, at least in part, for bedwetting. If both parents were bedwetters, a child has an 80% chance of being bedwetter as well. Experts believe other undetermined genes may also be involved in incontinence. Obstructive sleep apnea Bedwetting can be a sign of another condition called obstructive sleep apnea, in which a child's breathing is interrupted during sleep, often due to inflamed tonsils or adenoids. Other symptoms of this condition include snoring, mouth breathing, sinus infections, and sore throats. In some cases, successful treatment of these breathing disorders can also resolve the associated bedwetting. Structural problems Finally, a small number of cases of incontinence are caused by physical problems in the urinary system in children. A condition known as urinary reflux or vesico-reflux, in which urine backs up into one or both ureters, can cause urinary tract infections and incontinence. Nerve damage associated with the congenital anomaly spina bifida can cause incontinence. In these cases, incontinence may appear as a constant flow of urine. Causes of daytime incontinence Daytime incontinence that is not associated with a urinary tract infection or anatomical abnormalities is less common than nocturnal incontinence and tends to resolve sooner than nighttime incontinence. One possible cause of daytime incontinence is an overactive bladder. Many children have abnormal daytime incontinence, with more frequent urination being infrequent. This form of incontinence occurs more often in girls than in boys. Overactive bladder The muscles surrounding the urethra (the tube that carries urine from the bladder) are responsible for keeping the passage closed, preventing urine from passing out of the body. If the bladder contracts tightly and without warning, the muscles surrounding the urethra may not be able to hold in urine. This often occurs as a result of a urinary tract infection and is more common in girls. Retained urination Holding urination refers to a child's voluntary act of not urinating for extended periods of time. For example, a child may not want to use the restroom at school or may not want to interrupt enjoyable activities, so they ignore the body's signal of a full bladder. In these cases, the bladder may overflow and cause urine leakage. In addition, these children often develop urinary tract infections (UTIs), leading to an irritable or overactive bladder. Other causes Some of the factors that contribute to nocturnal incontinence can work in concert with frequent urination to produce daytime incontinence. These factors include a small bladder capacity, constipation, and eating foods containing caffeine, chocolate, or artificial colors. Treatment Growth and development Urinary incontinence sometimes heals naturally. Here are some examples of what can happen over time: Increases bladder capacity. Activation of alarm signals by the body in a natural way Overactive bladder sets in. ADH production becomes normal. The child learns to respond to the body's signals when it is time to urinate. Stopping stressful events Many children outgrow incontinence naturally (without treatment) as they age. The number of cases of incontinence decreases by 15% for each year after the age of 5. Medicines Bedwetting can be treated by increasing ADH levels. The hormone can be stimulated by a synthetic version called desmopressin or DDAVP , which has recently become 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 bedwetting. It acts on the brain and bladder. Unfortunately, drug treatment for bedwetting has little success, with the majority of cases relapsing once treatment is stopped. Bladder training and related strategies Bladder training involves exercises to strengthen and coordinate the bladder muscles and urethra and can help with urination control. These techniques teach the child to anticipate the need to urinate and avoid urinating when away from a toilet. Techniques that can help with nighttime incontinence include: Determination of bladder capacity Stretching of the bladder (delaying urination) Drink less fluid before going to sleep Develop routines for waking up Unfortunately, none of these answers have been proven to work. Techniques that can help with daytime incontinence include: Urinate on a schedule, such as every 2 hours (this is called timed voiding) Avoid caffeinated foods or other beverages (carbonated drinks) that can contribute to a child's incontinence Go to the toilet often during the day Bedwetting Treatment Alarms