Urinary Incontinence in Children
Parents or guardians of children who experience
bedwetting at night or accidents during the day should treat this problem with
understanding and patience. This loss of urinary control is called urinary
incontinence or just incontinence. Although it affects many young people, it
usually disappears naturally over time, which suggests that incontinence, for
some people, may be a normal part of growing up. Incontinence at the normal age
of toilet training may cause great distress. Daytime or nighttime incontinence
can be embarrassing. It is important to understand that many children experience
occasional incontinence and that treatment is available for most children who
have difficulty controlling their bladders.
How does the urinary system work?
Urination, or voiding, is a complex
activity. The bladder is a balloon-like organ that lies in the lowest part of
the abdomen. The bladder stores urine, then releases it through the urethra, the
canal that carries urine to the outside of the body. Controlling this activity
involves nerves, muscles, the spinal cord, and the brain.
The bladder is composed of two types of muscles: the detrusor, a muscular sac
that stores urine and squeezes to empty; and the sphincter, a circular group of
muscles at the bottom or neck of the bladder that automatically stay contracted
to hold the urine in and automatically relax when the detrusor contracts to let
the urine into the urethra. A third group of muscles below the bladder (pelvic
floor muscles) can contract to keep urine back.
A baby's bladder fills to a set point, then automatically contracts and
empties. As the child gets older, the nervous system matures. The child's brain
begins to get messages from the filling bladder and begins to send messages to
the bladder to keep it from automatically emptying until the child decides it is
the time and place to void.
Incontinence happens less often after age 5: About 10 percent of 5-year-olds,
5 percent of 10-year-olds, and 1 percent of 18-year-olds experience episodes of
incontinence. It is twice as common in boys as in girls.
Failures in this control mechanism result in incontinence. Reasons for this
failure range from simple to complex.
What causes nighttime incontinence?
After age 5, wetting at night—often
called bedwetting or sleepwetting—is more common than daytime wetting. Experts
do not know what causes nighttime incontinence. Young people who experience
nighttime wetting are usually physically and emotionally normal. Most cases
probably result from a mix of factors including slower physical development, an
overproduction of urine at night, a lack of ability to recognize bladder filling
when asleep, and, infrequently, anxiety. For many, there is a strong family
history of bedwetting, suggesting an inherited factor.
Slower Physical Development
Between the ages of 5 and 10, bedwetting may be
the result of a small bladder capacity, long sleeping periods, and
underdevelopment of the body's alarms that signal a full or emptying bladder.
This form of incontinence will fade away as the bladder grows and the natural
alarms become operational.
Excessive Output of Urine During Sleep
Normally, the body produces a hormone
that can slow the production of urine. This hormone is called antidiuretic
hormone, or ADH. The body normally produces more ADH at night so that the need
to urinate is lower. If the body doesn't produce enough ADH at night, the
production of urine may not be slowed down, leading to bladder overfilling. If a
child does not sense the bladder filling and awaken to urinate, then wetting
will occur.
Anxiety
Experts suggest that anxiety-causing events occurring in the lives of
children ages 2 to 4 might lead to incontinence before the child achieves total
bladder control. Anxiety experienced after age 4 might lead to wetting after the
child has been dry for a period of 6 months or more. Such events include angry
parents, unfamiliar social situations, and overwhelming family events such as
the birth of a brother or sister.
Incontinence itself is an anxiety-causing event. Strong bladder contractions
leading to leakage in the daytime can cause embarrassment and anxiety that lead
to wetting at night.
Genetics
Certain inherited genes appear to contribute to incontinence. In
1995, Swedish researchers announced they had found a site on human chromosome 13
that is responsible, at least in part, for nighttime wetting. If both parents
were bedwetters, a child has an 80 percent chance of also being a bedwetter.
Experts believe that other, undetermined genes also may be involved in
incontinence.
Obstructive Sleep Apnea
Nighttime incontinence may be one sign of another
condition called obstructive sleep apnea, in which the child's breathing is
interrupted during sleep, often because of inflamed or enlarged tonsils or
adenoids. Other symptoms of this condition include snoring, mouth breathing,
frequent ear and sinus infections, sore throat, choking, and daytime drowsiness.
In some cases, successful treatment of this breathing disorder may also resolve
the associated nighttime incontinence.
Structural Problems
Finally, a small number of cases of incontinence are
caused by physical problems in the urinary system in children. Rarely, a blocked
bladder or urethra may cause the bladder to overfill and leak. Nerve damage
associated with the birth defect spina bifida can cause incontinence. In these
cases, the incontinence can appear as a constant dribbling of urine.
Next: What causes daytime incontinence in children? »
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