Treatment of Urinary Incontinence in Children

Treatment of Urinary Incontinence in Children

Urinary incontinence in children, also known as bedwetting, is a common issue that can significantly affect a child's psychosocial and social well-being. While occasional incidents are normal for young children, persistent urinary incontinence can become a source of concern for parents and doctors alike. Understanding the underlying causes of this condition and exploring effective treatment methods with Dr. Enmar Mohamed Habib, Professor of Urology and Pediatric Urology at Cairo University and Fellow of McGill University, Canada, ensures that children can overcome this issue and regain self-confidence.

What is urinary incontinence in children?

Urinary incontinence is the loss of bladder control. Inability to control the bladder is normal in children under 3 years of age. As children get older, they gain more control over their bladders. When bedwetting occurs in a child old enough to control the bladder, it's referred to as enuresis or urinary incontinence. 
Girls usually tend to gain bladder control earlier than boys, leading to an earlier diagnosis of bedwetting in girls. However, urinary incontinence isn't considered an issue until a child reaches 5 years old. 
Bedwetting can occur either during the day or at night. Although it can be frustrating, it is crucial to be patient and understand that it is not the child's fault, as he has no control over it.

How does the urinary system work?

The urinary system includes the kidneys, ureters, bladder, and urethra. Urine is produced in the kidneys and then travels through the ureters to the bladder, which stores urine until it is excreted during urination. Emptying the bladder requires careful coordination between the brain, nerves, and muscles.
There are two main muscles involved in the urination process: The detrusor muscle and the urethral sphincter. These two muscles must work consistently, one contracting and the other relaxing to control the urine flow.  Any malfunction can lead to a partial loss of urinary control.

What are the types of urinary incontinence in children?

Urinary incontinence in children is divided into two main types:

• Nocturnal Enuresis (Nighttime Incontinence): Commonly known as bedwetting, it is the most frequent type among children over 5 years.
• Diurnal Enuresis (Daytime Incontinence): Occurs during waking hours and is more common in younger children.

Urinary incontinence can also be classified based on the timing of the symptoms into two types:

Primary Enuresis: Occurs when the child has not yet gained full control over urination and is still unable to control the bladder.
Secondary Enuresis: Occurs when the child has been able to control urination for at least six months, and then the symptoms reappear after this period.

What are the causes of urinary incontinence?

Bedwetting is a condition that can be caused by many potential and varied factors. Often, the exact cause of urinary incontinence is unknown, but several factors may contribute to its occurrence. Some of these causes may include one or more of the following factors:
• Anxiety: Mental stress and emotional distress can affect a child's ability to control the bladder during sleep.
• Constipation: Constipation can put additional pressure on the bladder, leading to urinary incontinence. It is important to diagnose and treat constipation before and during the treatment of urinary incontinence due to the close relationship between the digestive system and the bladder.
• Antidiuretic hormone (ADH) deficiency: ADH is a chemical naturally produced by the body that reduces the amount of urine produced by the kidneys. During deep sleep, the body releases this hormone, which helps retain fluids over night. However, in some cases, children may have a deficiency of this hormone during sleep, resulting in more urine being produced at night.
• Overactive bladder: An overactive bladder causes a sudden, urgent need to urinate and can be challenging to control. This type is known as urge incontinence.
• Small bladder: Some children may have a small bladder that cannot store enough urine at night.
• Congenital defects: Some birth defects, such as anatomical issues with the bladder or urinary system, can lead to urinary incontinence. For example, a spinal cord defect can cause the nerves in the bladder to malfunction, which leads to a neurogenic bladder. Urinary incontinence may also result from problems with the bladder muscles or its wall.
• Difficulty sensing bladder fullness during sleep: Some children cannot perceive the sensation of a full bladder while sleeping, which leads to nocturnal enuresis.
• Very deep sleep: Some children sleep very deeply, preventing them from waking up when their bladder is full.
• Urinary tract infection (UTI): A urinary tract infection can cause bladder irritation and contribute to urinary incontinence.
• Genetic factors: Certain genes may play a role in bedwetting, as well as a family history of the condition, which increases the likelihood of children developing urinary incontinence.
• High caffeine intake: Caffeine is a diuretic and increases the chances of urinary incontinence in children.

Treatment of urinary incontinence in children:

Dr. Enmar Mohamed Habib is highly skilled in treating complex cases of urinary incontinence in children, dealing with each case based on its underlying cause. He is also characterized by his great ability to deal sensitively and accurately with children, considering the delicacy of the area and the young age of the patients. Some of the treatments used include:
1. Initial treatment for nocturnal enuresis often involves behavioral modifications, such as using positive reinforcement, encouraging the child to urinate regularly during the day, setting regular wake-up times at night, and reducing fluid intake before bedtime. A chart can also be created to track the days when the child stays dry to monitor progress and improvement.
2. It is important to avoid caffeine in a child's diet. Caffeine is found in soft drinks such as cola and many other drinks, as well as black tea, coffee, and chocolate.
3. Bladder training includes exercises and urination on a schedule, such as encouraging the child to urinate every two hours, even if he does not feel the urge.
4. Drug treatment includes medications that help increase levels of antidiuretic hormone (ADH) or relax the bladder muscles.
5. In some cases, surgical treatment may be required to correct congenital defects in the urinary system, such as the installation of an artificial valve to help control urination. Additionally, the child may need surgery to enlarge the bladder using a portion of the intestine in cases of a small bladder. The child may also require catheterization to empty the bladder.

In conclusion, Dr. Enmar Mohamed Habib, Professor of Urology and Pediatric Urology at Cairo University and Fellow of McGill University, Canada, offers a comprehensive treatment for urinary incontinence in children, combining behavioral therapies, lifestyle modifications, and customized medical and surgical interventions. With his expertise in pediatric and adult urology, children receive outstanding care, helping them regain confidence and improve their lifestyle. Don't hesitate to get your consultation now.