What is urinary incontinence?

Urinary incontinence refers to the leakage of urine. It can be extremely frustrating and upsetting for both children and families. Each year, we treat more than 1,000 children for urinary incontinence. 

The different types of incontinence include:

• Urge incontinence: This is associated with frequent and urgent trips to the bathroom, accompanied by holding maneuvers such as squatting, dancing or crossing legs.
• Stress incontinence: This is associated with exercise, coughing, sneezing and/or lifting heavy objects. Though rare in children and adolescents, stress incontinence can develop in young women from high-impact sports such as gymnastics.
• Giggle incontinence: This is associated with laughing. Once a child starts urinating, they are unable to stop the flow of urine and usually soak their clothes.

Children with urinary incontinence may also have these conditions:

• Dysfunctional voiding: Children with dysfunctional voiding tend to tighten their pelvic floor muscles as they urinate, which may cut off their urine flow before the bladder is empty. This might leave behind a large amount of urine that leaks out afterwards.
• Underactive bladder: Children with underactive bladder use the bathroom only a few times per day, with little urge to urinate.
• Voiding postponement: This is associated with infrequent but urgent trips to the bathroom, accompanied by the habitual use of holding maneuvers to delay urination.
• Vaginal voiding: Girls with vaginal voiding trap a small amount of urine in the vagina that dribbles out after voiding. 

Causes

There are many reasons why children wet:

• Many children do not want to stop fun activities to go to the bathroom.
• Some children urinate only two to three times a day — they simply are too busy to go to the bathroom until it’s too late to make it to a toilet in time.
• Other children have uncontrolled bladder contractions that make them feel like they need to go to the bathroom “right now!”
• Children may sometimes ignore the signal to urinate or only notice once it becomes urgent enough to run to the bathroom.
• Some children do not fully empty their bladder when they do go to the bathroom, leaving residual urine behind.

Physical causes of wetting are rare. Children generally do not wet out of laziness or as a result of poor toilet training but rather, emotional and behavioral problems. If your child experiences persistent wetting, it may be necessary to address any underlying causes separately.

Treatment

Our DOVE Center is devoted to the treatment and management of children who have urinary incontinence. Our team will work with you to find and fix the causes of your child’s wetting accidents. We will recommend the best treatment plan for your child.

Steps involved in getting your child dry may include: 

• Urinating on a routine schedule of every two to three hours.
• Treating any underlying constipation.
• Increasing the amount of water consumed during the day.
• Avoiding drinks that irritate the bladder: caffeine, carbonation (fizz/bubbles), citrus juices and sports drinks.
• Proper positioning on the toilet.
• Biofeedback training: A way to teach children how to relax their pelvic floor muscles so they can empty their bladder fully.
• Behavior modification: Our team will educate you and your child about how the body works and recommend behavioral strategies specific to your child’s strengths. Our psychologists can also support behavior management around toileting and work with your child to address any obstacles that arise.
• Medication can be used in children with overactive bladders.
• We may recommend a pelvic health evaluation by the Physical Therapy team. These specialists will work with your child to help them properly use and strengthen the muscles that control the release of urine.
• Neuromodulation, which involves stimulating nerves that provide feedback to the brain-bladder connection, may also be an option in some cases. This can be done with skin patches or with a very small needle (like an acupuncture needle) placed near the ankle.