pediatrics
Urinary Incontinence in Children
Etiology of Urinary Incontinence In Children
Urinary incontinence in children has different causes and treatments than Urinary Incontinence in Adults . Although some abnormalities cause both nocturnal and diurnal incontinence, etiology typically varies depending on whether incontinence is nocturnal or diurnal, as well as primary or secondary. Most primary incontinence is nocturnal (ie, enuresis) and not due to an organic disorder. Enuresis can be divided into monosymptomatic (occurring only during sleep) and complex (other abnormalities are present, such as diurnal incontinence and/or urinary symptoms). Organic disorders account for about 30% of cases and are more common in complex compared to monosymptomatic enuresis. The remaining majority of cases are of unclear etiology but are thought to be due to a combination of factors, including Maturational delay Uncompleted Toilet Training None Functionally small bladder capacity (the bladder is not actually small but contracts before it is completely full) Increased nighttime urine volume Difficulties in arousal from sleep Family history (if one parent had nocturnal enuresis, there is a 30% chance offspring will have it, increasing to 70% if both parents were affected) About 15% per year resolve with no intervention. The factors contributing toorganic causes of enuresisinclude Conditions that increase urine volume (eg, Diabetes Mellitus in Children and Adolescents , Conditions that increase bladder irritability (eg, Urinary Tract Infection (UTI) in Children , pressure on the bladder by the rectum and sigmoid colon [caused by Structural abnormalities (eg, Ureteral Anomalies , which can cause both nocturnal and diurnal incontinence) Abnormal sphincter weakness (eg, Spina Bifida , which can cause both nocturnal and diurnal incontinence) Common causes of diurnal incontinence include Bladder irritability Relative weakness of the detrusor muscle (making it difficult to inhibit incontinence) Constipation in Children None Urethrovaginal reflux, or vaginal voiding: girls who use an incorrect position during voiding (eg, with legs close together) or have redundant skinfolds may have reflux of urine into the vagina, which subsequently leaks out on standing Structural abnormalities (eg, Ureteral Anomalies ) Abnormal sphincter weakness (eg, Spina Bifida , tethered cord) 