What is Urinary Incontinence in Children?
It means involuntary urinary incontinence during sleep after the age when the child attains urine control. It has two types, being the primary and the secondary. In the primary, the child has never attained urine control. In secondary, the child has maintained urine control for at least 6 months or for years but later, he has lost urine control.
Until What Age Does Children Leak Urine?
Leaking urine during night, which is called “Enuresis Urinary Incontinence”, occurs when children over 5 years of age involuntarily leak urine during night. Urinary incontinence in children younger than 5 years is accepted to be normal. That is because there is a lack of coordination between bladder and the brain. Rate of urinary incontinence over 5 years of age is 15 percent. The majority of these are mono symptomatic urinary incontinence. Meaning that urinary incontinence during night owes to a sole reason without the presence of additional disorders. It automatically disappears with the advancement of age. At 10 years of age, only 5 percent of children suffer urinary incontinence. This ratio falls to 1-2 percent at 15 years of age.
Other urinary incontinence is non-symptomatic urinary incontinence that has several causes. There are other accompanying disorders. More importantly, these patients also leak urine during day. These children also suffer frequent and painful urination. There is coordination disorder during the filling and discharge of the bladder. Treatment is sophisticated and requires more research.
Diagnosing Urinary Incontinence in Children
Diagnosis is simple. The family should consult a physician if their child has urinary incontinence during night. The child should be examined in terms of diabetes and constipation. Query is made into the frequency of nights when urinary incontinence occurs and the number of urine leaks during a single night. Daily urinary incontinence is queried. Stool traces are sought in the underwear. Research is made into functional disorders in the bladder and large intestine.
Treatment of Urinary Incontinence in Children
Education of the child and the approach by parents
One should never punish the child. Self-confidence in the child is restored. Gaseous drinks are forbidden during treatment. Caffeinated food and beverages should be refrained from. The child should drink plenty of water during the morning and noon. Drinking water during the night is restricted. Constipation should be treated always. The purpose is to reduce the number of nightly urinary incontinence within a week. If performed by experienced therapists, motivation and awarding treatment has a high rate of success.
A sensor that detects wetting is placed in the child’s underwear or under the bed and issues an audible warning to the child. The child wakes-up by sound or vibration and hold his urine. It is more efficient in children below seven years of age. It has 70 percent success rate.
Prescribed drugs prevent the excessive generation of urine by the kidneys. It is more efficient in mono symptomatic children (urinary incontinence due to sole reason). These provide that kidneys don’t generate urine that exceeds the filling capacity of the bladder. This drug reduces the urination volume of children and therefore prevents urinary incontinence. It yields results immediately. The drug is efficient as long as it is used. Urinary incontinence resumes after halting the drug.
Tricyclic Antidepressants have the same degree of effectiveness. These are also efficient in urinary incontinence that owes to multiple causes. It functions by increasing the bladder capacity, reducing urine generation during night and strengthening the urine retaining mechanism. Their use is low in our country due to their partial side effects on children. In many countries however, practitioners use as the first-step treatment.
What is the Procedure to be Followed in Stubborn Urinary Incontinence?
If nightly urinary incontinence persists despite all these treatments, research is made into the disorders of over active bladder, diabetes and sleep apnea. Psychological behavioral disorders in the child are examined. Hidden constipation may also lead to urinary incontinence, so the stool inside the whole large intestine is viewed by taking a flat abdominal radiograph. If the child is diagnosed with hidden constipation, its treatment is applied and nightly urinary incontinence might end. Any anomalies in the urinary system are searched into by ultrasonography. Functional disorders in the bladder are observed. Treatment is planned accordingly. Efficiency of tricyclic antidepressants in stubborn cases has been proven.