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Incontinence in children has different causes and treatment than that in adults. Incontinence can occur at night (bed-wetting, also called nocturnal enuresis—see Incontinence in Children: Urinary Incontinence in Children). Nocturnal enuresis is more common among boys, and children usually outgrow this type of incontinence by age 9. Incontinence during the daytime is sometimes called diurnal enuresis. Diurnal enuresis tends to be more common among girls and has a number of different causes.
Causes
The pattern of incontinence helps the doctor determine the likely cause. If the child has never had a consistent dry period during the day, the doctor considers the possibility of a birth defect, an anatomic abnormality, or certain behaviors that can lead to incontinence. A spinal cord defect such as spina bifida can cause nerve damage to the bladder and lead to incontinence, but such a defect is usually obvious. Some infants have a birth defect that prevents the bladder or urethra from developing completely, leading to nearly constant urine loss (total incontinence). Another type of birth defect causes the ureter to end outside the bladder, causing incontinence. Some children have an overactive bladder that easily spasms, or they have difficulty emptying their bladder.
Certain behaviors can lead to daytime incontinence, especially in girls. Such behaviors include urinating infrequently and urinating using an incorrect position, which can cause urine to leak into the vagina, then dribble out after standing. Some girls experience bladder spasm when laughing, resulting in “giggle incontinence.”
If the child has been dry for a long time and the incontinence is new, the doctor considers conditions that intermittently cause difficulties. These include constipation, diet, emotional stress, infections, and sexual abuse. Bacterial urinary tract infections and viral infections that lead to bladder irritation (viral cystitis) are common infectious causes. To prevent urine from leaking, many children with incontinence cross their legs or use other postures, which may increase the chance of developing a urinary tract infection. Sexually active adolescents can have urinary difficulties from certain sexually transmitted diseases. Caffeine and acidic juices, such as orange and tomato juice, can irritate the bladder and lead to leakage of urine. Children with diabetes mellitus or diabetes insipidus (a disorder resulting in excessive amounts of dilute urine) can develop incontinence because these disorders result in production of excessive amounts of urine.
Diagnosis
Sometimes doctors can diagnose the cause by the child's symptoms and the results of an examination. To check for an infection, a urinalysis and sometimes a urine culture is done. To check for diabetes mellitus and diabetes insipidus, doctors use blood and urine tests to check sugar and electrolyte levels. If a birth defect is suspected, an ultrasound examination of the kidneys and bladder and x-rays of the spine may be necessary. A special x-ray of the bladder and kidneys, called a voiding cystourethrogram, may also be necessary. 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.
Treatment
Treatment depends on the cause of the incontinence. An infection is usually treated with antibiotics. Relieving and preventing constipation, urinating at 2- to 3-hour intervals, using a technique called biofeedback for an overactive bladder, and changing other behaviors may be effective depending on the cause. Dietary changes can help decrease bladder irritants. If behavioral interventions are not effective, certain drugs (such as oxybutynin) may help if the cause is bladder spasm. Children with birth defects or anatomic abnormalities may need surgery, drugs, or intermittent catheterization.
Last full review/revision October 2007 by Joseph G. Ouslander, MD
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