urinary incontinence in children
children s health issues
Urinary Incontinence in Children
Learning about the cause and course of incontinence helps decrease the negative psychologic impact of urine accidents. Doctors ask how the child is being impacted by the incontinence because that could affect the treatment decisions. Treatment of incontinence depends on the cause of the incontinence. For example, an infection is usually treated with antibiotics. Children with birth defects or anatomic abnormalities may need surgery. Successful treatment of urinary incontinence also depends on parent and child participation in the treatment plan. If the child is immature, not bothered by the wetting, or unwilling to participate in the treatment plan, the plan should be postponed until the child is ready to participate. Other measures can be taken depending on whether incontinence is at night or during the day. Doctors typically tell parents to begin with behavioral modifications for their child. Modifications include the following: Limiting how much the child drinks in the evening—80% of daily liquids should be consumed before 5 PM Limiting liquids 2 hours before sleep Urinating 2 times consecutively before sleep (called double-voiding) Managing constipation appropriately The most effective long-term strategy is a bed-wetting alarm. Although labor intensive, the success rate can be as high as 70% when children are motivated to end the bed-wetting, and the family is able to follow the plan. It can take up to 4 months of nightly use for symptoms to completely resolve. Parents should not punish children for bed-wetting. Punishment only undermines treatment and causes poor self-esteem. Each year, enuresis tends to resolve without treatment in about 15% of affected children as they grow. Medications given by mouth such asdesmopressin(DDAVP) andimipraminecan decrease the number of bed-wetting episodes. However, bed-wetting resumes in most children when the medications are stopped. Parents and children should be warned of this likelihood so that the child does not become devastated if bed-wetting starts again.Imipramineis now rarely given because it may rarely cause sudden death. General measures may include Trying urgency containment exercises (to strengthen the urinary sphincter) Gradually lengthening the time between visits to the bathroom (if the child is thought to have a weak bladder muscle or dysfunctional voiding) Changing behavior (for example, delaying urination) through positive reinforcement and scheduled urination Reminding children to urinate by a clock that vibrates or sounds an alarm (this is preferable to having a parent in the reminder role) Using methods that discourage retention of urine in the vagina (for example, sitting facing backward on the toilet or with the knees wide apart) Teaching children how to exercise and control the pelvic floor muscles (the uterus, vagina, bladder, urethra, and rectum) and abdomen muscles to promote coordinated urination (using Biofeedback ) Urgency containment exercises involve telling children to go to the bathroom as soon as they feel the urge to urinate. But once in the bathroom, they are asked to hold the urine as long as they can. When they can hold it no longer they should start to urinate but then stop and start urinating every few seconds. This exercise strengthens the urinary sphincter and also gives children confidence that they can make it to the bathroom before they have an accident. This exercise should be taught after the child has been evaluated by a doctor. Girls who have adhesions are given a cream that contains estrogen. Certain medications given my mouth may help children who have daytime incontinence.Oxybutyninandtolterodinecan help if the problem is bladder spasm.Solifenacin,darifenacin, andmirabegronmay help children who have an overactive bladder. 