Urinary Incontinence Problem in Children

By | 30 March 2021

Urinary Incontinence Problem in Children  Wetting at inappropriate times in childhood is a common situation and constitutes 40% of the patients who come to the pediatric urology outpatient clinic. This situation can manifest itself only as nocturnal incontinence or urinary incontinence both day and night.

Normally, children provide nighttime urine control at the age of 4, and daytime control is provided before. As studies conducted in our country and abroad show, 15% of 5-year-olds and 1% of 15-year-olds have urinary incontinence at night. Although 15% of children with nocturnal incontinence recover spontaneously every year without any treatment, the most important indicator of the need for treatment is that the problem of diaper wetting causes social and psychological problems in both the child and the family during this time period.

Primary Enuresis Nocturna:
It is the state of wetting the diaper during sleep without any complaints during the day.
The reason for this is multifactorial and positive family history, low functional bladder capacity, ADH deficiency, and night awakening problems are the main ones.

Day-Night Soaking:
a. Dysfunctional Urination: It is a problem that manifests itself in the form of urinating by contracting the sphincter and pelvic floor muscles that are used to hold urine at the bladder floor during the bladder emptying phase as a result of the child’s inaccurate urination training, and the inability to empty the bladder after voiding at intervals caused by the disruption in the bladder dynamics. Constipation is also a common condition in these cases.
b. Urge Syndrome: It is the situation in which urinary incontinence occurs due to the involuntary contraction of the bladder and the pressure increase resulting from these contractions before the amount of urine in the bladder reaches its capacity in the bladder filling phase.
c. Less Active Bladder: This is the least common condition in this group, and it manifests itself when the bladder cannot contract enough to empty urine and urine remains in the bladder after voiding.

Urinary Incontinence Problem in Children While Laughing:
It is a situation in which urine control is lost during very severe laughing, which can be seen in boys, although it is mostly seen in adolescent girls. It is defined as a developmental problem due to the proximity of laughter and bladder control centers in the brain. It is a disease that resolves spontaneously over time and can be added to drug therapy in some cases.

Treatment
The success of the treatment is the correct diagnosis of the child according to the above classification and the planning of the treatment accordingly. Treatment alternatives according to the classification are as follows.

Primary Enuresis Nocturna
Restriction of liquid drinks and foods took before bedtime: It is a method based on reducing fluid intake in the 1-2 hour period close to bedtime and not taking sugary and caffeinated beverages with the thought that bladder contractions increase.
Urinating by waking up children at certain times: This method, which is applied by most families before consulting a doctor, is a method that is not very useful in the long term but can be applied with fluid restriction as part of the treatment.
Alarm devices: It is based on the principle that the child wakes up with the alarm that warns when the urine touches the device during sleep and then goes to the toilet to urinate and is a very successful method in the long term. Requiring constant parental supervision is a disadvantage.

Dysfunctional Urination:
Urination Therapy:
It is a form of treatment aimed at correcting toilet habits and diet, if necessary, in children with urinary incontinence.

Biofeedback Therapy:
It is a treatment method that aims to teach the physiological body activities that the patient does not normally know, with computers and similar devices. With this method, it is aimed to correct the wrong behaviors that the patient has done for many years, which are the cause of urinary incontinence and disrupt the bladder dynamics, and to prevent urinary incontinence.

In the pediatric age group, it enables the learning of completely normal physiology after 4-6 sessions, especially if the bladder contracts to urinate and then the sphincter that needs to be relaxed cannot be relaxed. Biofeedback provides correction of other complications of voiding dysfunction in selected cases without being exposed to difficult situations such as surgery.