urinary incontinence in children
children s health issues
Urinary Incontinence in Children
Doctors first try to determine whether incontinence is simply a developmental issue or whether a disorder is involved. In children with urinary incontinence, certain signs and characteristics are cause for concern. They include Signs or concerns of sexual abuse Excessive thirst, excessive volume of urine, and/or weight loss Incontinence during the day in children 6 years of age or older Any signs of nerve damage, especially in the legs Signs of an abnormality of the spine Newly developed incontinence in children who have been dry for over 1 year Signs of nerve damage in the legs include weakness in, or difficulty moving, one or both legs and complaints that the legs "feel funny." Signs of an abnormality of the spine include a deep pit or dimple or an unusual patch of hair in the middle of the lower back. Children who have any warning sign should immediately be brought to a doctor with experience in treating children unless the only warning sign is daytime incontinence in children who are 6 years of age or older. Such children should see a doctor at some point, but a delay of a week or so is not harmful. Doctors first ask questions about the child's symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination often suggests a cause of the incontinence and the tests that may need to be done (see tableand table). In the medical history, doctors ask about when symptoms began, timing of symptoms, and whether symptoms are continuous (that is, constant dribbling) or intermittent. Having the parents record the timing, frequency, and volume of urine (a voiding diary) and the frequency, size, and consistency of stool (a stooling diary) in a journal can be helpful. Position while urinating and strength of urine stream are discussed. Some symptoms that suggest a cause include Decreased frequency of stools and/or hard or unusually large stools ( Constipation in Children ) Fever, abdominal pain, pain while urinating, and increased urgency to pass urine ( Urinary Tract Infection (UTI) in Children ) Itching around the anus, rectum, or vagina ( Pinworm Infection ) deficiency [ ArginineVasopressin Deficiency (Central Diabetes Insipidus) ], Snoring or breathing pauses during sleep and being excessively sleepy during the day ( Sleep Apnea ) Doctors also ask about any history of birth injuries or birth defects (such as spina bifida), nerve disorders, kidney disorders, and urinary tract infections. Doctors Sexual abuse , which, although an uncommon cause, is too important to miss. If there is a family history of bed-wetting or any urologic disorders, these should be brought to the doctors' attention. Doctors also ask questions about any stressors occurring near the start of symptoms, including difficulties at school, with friends, or at home (including questions about parents' marital difficulties). Although incontinence is not a psychologic disorder, a brief period of wetting may occur during times of psychologic stress. Doctors ask whether children feel weakness of the legs when running or standing. Doctors then do a physical examination. Examination begins with the following: A review of vital signs for fever (may indicate a urinary tract infection), weight loss and excessive thirst (may indicate diabetes), and hypertension (may indicate a kidney disorder) Examination of the head and neck for enlarged tonsils, mouth breathing, or poor growth (may indicate sleep apnea) Examination of the abdomen for any masses that suggest stool is being retained or for a full bladder Examination of the genitals in girls for any adhesions (when the lips of the vagina stick together), scarring, or signs suggesting sexual abuse Examination of the genitals in boys for any irritation or lesions on the penis or around the anus or rectum Examination of the spine for any defects (for example, a tuft of hair or a dimple at the base of the spine) A neurologic examination to evaluate leg strength, sensation, deep tendon reflexes, and other reflexes (such as lightly touching the anus to see whether it constricts—called the anal wink—and, in boys, lightly stroking the inner thigh to see whether the testis is pulled up—called the cremasteric reflex) A rectal examination may be done during the physical examination to detect constipation or decreased rectal tone Often doctors can diagnose the cause by the history, physical examination, a urinalysis, and a urine culture. Doctors may do other tests depending on what they find during their evaluation (see tableand table). For example, to help diagnose diabetes mellitus and diabetes insipidus, doctors do blood and urine tests to check sugar and electrolyte levels. To diagnose urinary tract infection, doctors do a urinalysis and urine culture. If a birth defect is suspected, an ultrasound examination of the kidneys and bladder and x-rays of the spine may be necessary. Ultrasonography also can be used to determine the size of the rectum. An x-ray of the abdomen may done to confirm the presence of a large amount of stool. A special x-ray of the bladder and kidneys, called a Cystography and cystourethrography , may also be needed. With this test, a dye is injected into the bladder using a catheter, which shows the anatomy of the urinary tract as well as the direction of urine flow. 