A Quick Guide to Paediatric Urinary Incontinence
Published: 22 June 2019
Published: 22 June 2019
Though paediatric urinary incontinence may be concerning for the child and parent(s) involved, it's quite common – and it’s very likely that you will frequently encounter this issue in your work.
Typically, a child will have achieved daytime bladder control by the age of four (Continence Foundation of Australia 2020). When this doesn’t occur, and a child is still prone to wetting at inappropriate times or during the night, intervention is required.
Urinary incontinence can have a significant negative impact on a child’s psychosocial wellbeing and affect their day-to-day life. Fortunately, there are many treatment options available.
This article will discuss the presentation and treatment of paediatric urinary incontinence.
Paediatric urinary incontinence refers to the inability of a child to control their bladder, which results in wetting (Continence Foundation of Australia 2020).
Children usually attain continence during the day by the age of four. Nighttime continence usually takes longer to achieve and generally occurs by the age of seven or eight (Continence Foundation of Australia 2020, 2022).
Note: These age indicators may not be applicable to children with developmental delay, and are therefore based on children who are developing typically (Figueroa 2018).
Paediatric urinary incontinence is separated into two distinct categories:
Diurnal incontinence (or day wetting) is urinary incontinence during the day, which is not diagnosed until after the age of five (RCHM 2018).
Enuresis (or bed-wetting) is urinary incontinence at night (Continence Foundation of Australia 2022).
(Nankivell & Caldwell 2014; Figueroa 2018)
Paediatric urinary incontinence is defined as the involuntarily voiding of urine at least once per month for at least three months in a child over the age of five (RCHM 2018).
As is understood, the bladder has a dual function: to store and eliminate urine. Paediatric urinary incontinence occurs when the child is unable to carry out the following actions:
Common problems that are to be observed are:
(Continence Foundation of Australia 2020)
Urinary tract infections, constipation and stress should be considered as possible contributing factors of urinary incontinence (Raising Children Network 2020).
Often, children will present with other lower urinary tract (LUT) symptoms such as:
(Nankivell & Caldwell 2014)
If urinary incontinence is suspected, the child should first be assessed by a general practitioner (GP). The GP will undertake a physical examination of the child’s abdomen, lower back and genitals and may also test the child’s urine (Raising Children Australia 2020).
There are several options available for the treatment and management of paediatric urinary incontinence.
The first-line treatment for children with this condition is usually urotherapy - a nonpharmacological and nonsurgical intervention that involves behaviour modification (Raising Children Australia 2020).
Urotherapy involves:
(Nankivell & Caldwell 2014; Raising Children Network 2020)
Other potential interventions include alarm training (placing wetness sensors under the bedsheets or in the child's underpants to wake them up when they are wet) and prescribed medications such as desmopressin may also be recommended (Nankivell & Caldwell 2014).
Family education about the cause and clinical course of incontinence is important in order to reduce stigma and assist with treatment.
Incontinence can, in most cases, be prevented by learning and practising particular healthy habits.
To prevent any form of incontinence, it's important to encourage the child to be physically active, learn and practice good toilet habits, drink plenty of fluids, and overall endeavour to make and maintain a healthy lifestyle.
Children may need to be referred to a specialist if:
(Nankivell & Caldwell 2014)
Paediatric diurnal incontinence and enuresis are frequently encountered in general practice, as they are common issues in school-aged children.
Effective treatment is enormously beneficial for the child, their wellbeing and their self-esteem. The stigma surrounding urinary incontinence should not be underestimated.
To determine the most effective treatment and to reach an accurate diagnosis, a detailed assessment of family history and examination are crucial.
Question 1 of 3
Which of the following is usually achieved first?