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Urinary Incontinence

15% of children struggle at some point with urinary incontinence.  Although childhood incontinence is relatively common, the causes are widely misunderstood and seldom discussed with pediatricians.  It is often assumed to be a behavioral issue or an indicator of abuse, but it can be related to many other things such as

  • Constipation – More than 50% those with urinary voiding dysfunction also have constipation.
  • Urinary tract infections – Approximately 40% of children experiencing a first-time UTI and approximately 80% of children with recurrent UTIs have underlying urinary voiding dysfunction, but it is very often overlooked or missed. 
  • Poor toileting habits or infrequent voiding – Kids don’t like to be disturbed while engrossed in play, and are likely to ignore the urge to void in order to keep playing.  This can result in an enlarged bladder with decreased conscious control and/or sensation or urinary urge.  Less than 3 or more than 8 urinary voids per day is usually indicative of a concern. 
  • Delayed control of the bladder during the overnight hours – Control of the bladder during the overnight hours can lag up to 10 months behind daytime control of the bladder.  1-3% of children who struggle with bedwetting still have difficulty at 18 years of age because their body fails to produce a hormone necessary to regulate overnight kidney function. 
  • Weakness, incoordination or overactivity in the pelvic floor and/or core muscles
  • Poor nutritional habits – Consumption of foods known to irritate the urinary tract and contribute to overactive bladder.
  • Congenital abnormalities in the urinary tract
  • Injury to pelvic organs or pelvic floor musculature
  • Conditions such as kidney disease or diabetes, as well as various medical treatments




Bedwetting

Most children achieve overnight continence around age 5 (give or take), but approximately 10-15% of children beyond age 5 struggle with bedwetting 3 or more nights each week (this makes bedwetting almost as common as asthma!).  All children have a 10% chance of struggling with bedwetting, but the likelihood increases to 44% if one parent struggled with bedwetting, and 77% if both parents struggled with bedwetting.  Bedwetting can occur for different reasons and, like daytime incontinence, is generally not behavioral. 


  • Most bedwetting children are very difficult to arouse at night
  • Many children have kidneys that produce too much urine at night
  • The bladder may be smaller or contract too frequently in children who experience bedwetting


If your child is 5 year or older and wets the bed 3 or more times each week, talk to your pediatrician.  The pediatrician can evaluate your child for other problems potentially related to bedwetting.  Under the right circumstances they may recommend a common medication to lessen overproduction of urine during the night and/or they may recommend physical therapy.  It is important to remember that if your child is having daytime accidents or constipation, it is essential to resolve these problems before specifically addressing the bedwetting.  Quite often, bedwetting improves or resolves spontaneously as daytime incontinence issues resolve.
 


Giggle Incontinence

The name of this dysfunction is relatively deceiving.  Unlike stress incontinence, which is typically small leaks of urine when laughing, sneezing or coughing, giggle incontinence results in nearly complete emptying of the bladder with laughing.  It is often seen in teenage girls, and is something that is often “outgrown” if not addressed in any other way.   

 

Overactive Bladder

Unless you hydrate more than the average person, if you urinate more frequently than every 3-4 hours, your bladder may be overactive.  Overactive bladder can be caused by consumption of beverages and foods that are irritating to the bladder.  It can also be caused by irritation of the muscle that controls the bladder; this irritation can often be caused by constipation. 

 

Post-Void Residual / Urinary Retention / Incomplete Bladder Emptying

Incomplete bladder emptying can often be confused with Overactive Bladder, since not emptying fully will cause you to sense a full bladder quicker.  Those not experiencing overactive bladder symptoms might urinate very infrequently; in this case, the capacity of the bladder gradually expands beyond normal capacity.  Being consistently over-expanded causes the bladder’s muscle to also stretch and lose contractile properties when not filled beyond normal capacity, making it difficult to void small amounts of urine. 

 

FREQUENT URINARY TRACT INFECTION (UTI)

As noted above, approximately 40% of children experiencing a first-time UTI and approximately 80% of children with recurrent UTIs have underlying urinary voiding dysfunction, but it is often overlooked and undiagnosed.  Recurrent infections have the potential to cause damage and scarring within the kidneys and other parts of the urinary tract.  There are many possible causes for repeated urinary tract infections, including vesicoureteral reflux or dysfunction within the pelvic floor. 



vESICOURETERAL REFLUX

Usually identified during infancy or childhood, VUR is backward flow if urine from the bladder back into the kidneys.  This creates significant risk for infection in the kidneys, as well as significant risk of scarring within the kidneys.  Significant damage within the kidneys creates risk hypertension and disrupted urine output.

 

CONSTIPATION

For a multitude of reasons, constipation is a very common pediatric condition, effecting up to 30% of children.  By definition, it is the severe difficulty or inability to pass stool; it can be caused by poor hydration, low fiber intake, high intake of food known to slow passage or stool, and/or lack of physical activity.  Children are considered to be constipated if they

  • Regularly struggle to produce a bowel movement or evacuate stool from their body
  • If they produce stool that is dry, hard or very large
  • Iif  they have fewer than 3 bowel movements per week.

Children with constipation may experience ‘breakthrough’ of ‘overflow’ diarrhea while constipated; this occurs when soft or liquid fecal matter seeps around a mass of hardened or solidified stool that is stopped within the bowel.  Constipation can cause enlargement of the bowels, as the mass of stalled fecal matter grows; enlargement of the bowel results in stretching of the muscles responsible for stool movement, which results in the muscles working with less force to move stool through the bowel.  Stool become larger, and then uncomfortable or painful to evacuate.  Painful evacuation of stool often leads to further constipation, as children will avoid bowel movements in order to avoid more pain. 



Encopresis

Involuntary leaking of stool, many times after already having regular control of the bowels.  Encopresis is often seen in children with constipation, as they have difficulty managing breakthrough or overflow diarrhea.