.png)
What is urinary incontinence?
Urinary incontinence is the involuntary loss of urine. It is divided into daytime urinary incontinence, i.e. when the child is awake, and enuresis, the involuntary loss of urine during sleep, including naptime.
When is urinary incontinence normal?
Up to the age of 5 years, enuresis is considered a normal phenomenon and is due to insufficient maturation of the parts of the brain responsible for bladder control. Already at the age of 3 years, many children manage to be dry during the day. The timing of achieving this varies from person to person and is a leap in development that must be actively supported by parents, without putting pressure on the child. Bladder training can begin as early as 18 months of age if the child shows corresponding signs of maturity, such as full control over stool elimination, dry diapering for longer periods of time, reluctance to wear a diaper. The age of 24 months is considered the latest for the start of training. The main objective is to ensure a smooth transition to nappy-free life and to avoid putting pressure or creating guilt in the child.
How common is urinary incontinence?
The incidence of enuresis at age 7 is around 10% and is twice as common in boys as in girls. At the age of 10 years, a rate of 5% is still not dry, while at the age of 16 years this rate drops to around 1%. In the case of daytime urinary incontinence, girls experience it more often than boys. At the age of 7 years, the incidence is 3-5%. We believe that these rates are much higher, considering that only 1/3 of patients seek medical help.
Why might a child have urinary incontinence?
Daytime urinary incontinence may be due to pathological causes, such as urinary tract abnormalities or neurological damage. Sometimes, these abnormalities are diagnosed at birth, but very often they remain undiagnosed for several years. Their diagnosis can be easily established through a thorough history, a thorough clinical examination and a specialist urinary tract ultrasound scan. However, it must be stressed that sometimes the causes are simpler and are mainly related to wrong habits, such as forgetting to go to the toilet or going too often.
In the case of enuresis, there are two main criteria for separation. The first criterion is the coexistence or not of a bladder dysfunction during the day. In the first case, the treatment of this must precede the treatment of the enuresis and the enuresis is classified as non-monosymptomatic. This category includes 2/3 of children with enuresis. Symptoms include very frequent stools, urinary retention and a strong urge to urinate. Daytime urinary incontinence does not always coexist, which is why these problems often go undiagnosed, but their diagnosis is crucial for proper treatment.
In the second case, lack of bladder dysfunction, a form of heredity occurs. If one parent had enuresis, the probability of the child having the same is 44%, while if both parents had it, the probability reaches 77%. This form is classified as monosymptomatic enuresis. The causes of monosymptomatic enuresis are multiple, deep sleep, immaturity of the bladder control centre and a large amount of urine at night that exceeds the capacity of the bladder. Involuntary bladder emptying can occur in any non-REM phase of sleep, but mainly in the first third of it. Children with enuresis often present with gloom, lack of self-esteem and reduced quality of life. These symptoms subside with treatment of enuresis.
The second criterion for distinguishing enuresis, which is also a criterion for urine loss during the day, is the recurrence phenomenon. In the case of recurrence of urinary incontinence in children who have been dry for more than 6 months, we speak of secondary incontinence and secondary enuresis. In this category of patients, the probability that the causes are psychological is increased.
In conclusion, urinary incontinence, in any form, day or night, affects a large part of the population and affects the psychology and daily life of all those involved (children, siblings, parents). However, by seeking qualified help and correct and timely diagnosis, it is possible to cope.
Eleftheria Kostantinis
Paediatrician - Paediatric nephrologist
.svg)
.svg)
.svg)
.png)
