Urinary Incontinence in Children

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Medical Author:

David Perlstein, MD, MBA, FAAP

David Perlstein, MD, MBA, FAAP

Dr. Perlstein received his Medical Degree from the University of Cincinnati and then completed his internship and residency in pediatrics at The New York Hospital, Cornell medical Center in New York City. After serving an additional year as Chief Pediatric Resident, he worked as a private practitioner and then was appointed Director of Ambulatory Pediatrics at St. Barnabas Hospital in the Bronx.

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Medical Editor:

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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• Urinary incontinence in children is very common.



• Nighttime wetting (nocturnal enuresis) is more common than daytime wetting (diurnal enuresis).



• Most urinary incontinence is nonorganic and resolves without intervention.



• Persistent primary enuresis and secondary enuresis may require further medical evaluation.



• Treatment for most cases of enuresis involves behavioral modification.



• Bedwetting alarms are very effective.



• Medications should be reserved for select children.



• Less than 1% of all affected children have persistent incontinence into adulthood.

Very simply stated, urinary incontinence is defined as the loss of complete control of the act of urination or the involuntary emptying of the bladder. It is also referred to as enuresis. It can be caused by any number of factors, and in young infants and toddlers, it is usually completely normal. In order to understand the different causes better, one must have some basic understanding of processes involved in urination

The urinary system is made up of the kidneys, ureters, bladder, and urethra. Urine is produced by the kidneys and drains via the ureters to the bladder. The bladder serves as the storage tank, stowing the urine until emptied through micturition (urinating). The act of emptying the bladder requires significant coordination between the brain, nerves, and muscles. There are two major muscles involved in urination, the detrusor and the sphincter. The detrusor is a large muscle which contracts to squeeze urine out of the bladder, and the sphincter is a group of muscles which remains contracted to keep urine in the bladder. These two muscles must work in concert, one contracting while the other relaxes, to control the flow of urine. Dysfunction in either may result in some degree of loss of urinary control. The urethra serves as the canal which carries the urine from the bladder during voiding. Achieving bladder control must be learned, and some children learn earlier than others, and therefore urinary incontinence is normal in most young infants and children, but in older children and adolescents, it is not considered normal.