Urinary Incontinence in Children

Urinary incontinence is a common condition during childhood. This condition may manifest itself as urinary incontinence only at night (nocturnal enuresis), incontinence only during the day, or urinary incontinence both day and night. Conscious perception of bladder fullness begins between the ages of 1 and 2. Voluntary starting or stopping of urination develops between the ages of 2 and 3. Since urinary incontinence may occur in many anatomical or functional urinary system anomalies, tubular diseases or systemic diseases, the child with urinary incontinence should be evaluated.

Why do children leak urine during the day?

Daytime or both day and night urinary incontinence, which can have a variety of causes, can be a sign of a serious condition. Daytime or nighttime urinary incontinence may be caused by structural reasons such as neurogenic and anatomical disorders, or by functional reasons. The most common voiding disorder is overactive bladder.

Overactive bladder: Children with overactive bladder pee frequently (more than 7 times a day) and in small amounts. This condition is accompanied by a feeling of urgency to urinate and urinary incontinence when unable to urinate. When the child urinates due to the urgent feeling of urination, he tries not to leak urine by performing urinary retention maneuvers (such as crossing his legs, squatting, squeezing his genitals with his hand) by contracting his pelvic floor muscles.

Delayed urination (underactive bladder): It is seen in children who delay urination with urinary retention maneuvers. These children hold their urine with urinary retention maneuvers and do not go to the toilet, even if they need to urinate while playing games, playing the computer or at school. They usually go to the toilet less than 3 times a day.

Children with delayed urination pee less than 3 times a day and delay urination until the last minute, and when the bladder is full, the urine overflows. Their urine stream is weak and they urinate by straining. These children do not want to urinate when they wake up in the morning. Because they hold their urine, their bladders expand, bladder muscle tone decreases, and since the bladder cannot be emptied completely, residual urine remains in the bladder after urination. Residual urine can also cause a urinary tract infection.

Dysfunctional urination: It is the situation where the external sphincter cannot be relaxed sufficiently or there are intermittent contractions during urination. Due to increased pelvic floor muscle activity, the child urinates against resistance and urination disorders occur. These children, who delay urination with holding maneuvers, start urinating late, urinate intermittently, often have constipation problems and urinary incontinence.

Laughing incontinence: It is a condition usually seen in girls, the cause of which is not fully known. Urine leaks suddenly while laughing.

How to diagnose?

Detailed questioning of patients presenting with urinary incontinence, their urinary habits, defecation habits and the presence of previous urinary tract infections greatly helps in identifying different reasons that may cause urinary incontinence. Frequent going to the toilet (more than 7 times a day), less going to the toilet (less than 3 times a day), feeling of urgency (leaks urine when unable to reach it), difficulty in starting to urinate, intermittent urination, urination with a weak stream, crossing legs and squatting when urinating. If there are complaints, the child should be evaluated for urination disorder.

Diaries in which children’s urination frequency, amount of urination and incontinence times are recorded for at least 2 days are useful for evaluating urination and fluid intake habits. Complete urinalysis, uroflowmeter, ultrasonography and evaluation of the upper and lower urinary tract are simple diagnostic methods. Urodynamic examination and voiding cystourethrography may be required in selected cases or in those who fail initial treatment.

How is it treated?

It is a condition that needs to be treated because it can cause urinary disorders, urinary tract infection, vesicoureteral reflux and kidney damage. Different treatment approaches are applied in the treatment of children with daytime urinary incontinence, depending on the underlying cause. Methods such as bladder training, prevention of constipation, pelvic floor exercises, biofeedback, and clean intermittent catheterization when necessary can be used in treatment. As pharmacological treatment, alpha-blockers, especially anticholinergic drugs, can be used in selected cases.

As a result, daytime urinary incontinence is a common condition in children and may cause serious complications in the long term, depending on the underlying cause. Determining the cause through detailed history, physical examination and step-by-step evaluation and applying appropriate treatment methods early is important to prevent possible complications.