A Quick Guide to Paediatric Urinary Incontinence
Published: 23 June 2019
Published: 23 June 2019
Typically, a child will have achieved daytime bladder control by the age of four. 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.
Children usually attain continence during the day by age four or five. Nighttime continence usually takes longer to achieve.
(Nankivell & Caldwell 2014; Figueroa 2018)
To be considered as presenting with paediatric urinary incontinence: the child will involuntarily void urine at least once per month for up to three months (The Royal Children’s Hospital Melbourne 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:
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 the age of 5 or 6; and
Enuresis (or bed-wetting) is urinary incontinence at night. The child can be diagnosed as having nocturnal (nighttime) incontinence by the age of 7.
(Nankivell & Caldwell 2014)
These age indicators may not be applicable to children with developmental delay, and are therefore based on children who are developing typically (Figueroa 2018).
Common problems that are to be observed are:
(Continence Foundation of Australia 2019)
Urinary tract infections, constipation and stress should be considered as possible factors of urinary incontinence (Raising Children Network 2017).
Often children will present other lower urinary tract (LUT) symptoms such as:
(Nankivell & Caldwell 2014)
There are many options available for the treatment and management of paediatric urinary incontinence.
The first-line of therapy for children with this condition is urotherapy. Urotherapy is a nonpharmacological and nonsurgical intervention frequently used to treat lower urinal tract and bowel dysfunction.
In terms of assessment, a general practitioner (GP) will undertake a physical examination of the child’s stomach, lower back and genitals; the GP might also test the child’s urine (Raising Children Australia 2017.)
Urotherapy involves:
It also encompasses:
(Figueroa 2018; Horowitz & Misseri 2007; Maternik et al. 2015; Nankivell & Caldwell 2014; Raising Children Network 2017)
If urotherapy alone is deemed to be insufficient, a combination of alarm training and prescribed medications may be recommended.
Family education about the cause and clinical course of incontinence is important 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 is important to encourage patients to be physically active, learn and practice good toilet habits, drink plenty of fluids, and overall endeavour to make and maintain a healthy lifestyle.
Patients should be referred on to a specialist in the following cases, or when treatment is not successful after roughly six months (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 in their wellbeing and 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.
Caring for someone with incontinence: A page and video resources dedicated to carers who are looking after someone with incontinence.
Webinar library: Several video resources on incontinence.
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