What is daytime urinary incontinence?
Daytime urinary incontinence is urine leakage that cannot be controlled while the child is awake. These urine leaks can vary from dripping to wetting the place where it is located.
How common is daytime urinary incontinence?
Daytime wetting is twice as common in girls than boys. About 8-10% of children between the ages of 4 and 12 experience daytime wetting. It is most common among school-age children.
What is the cause of daytime urinary incontinence?
Daytime urinary incontinence can occur due to many reasons. The basis or result of these causes lies in the dysfunction of the pelvic floor muscles.
- Overactive bladder: An overactive bladder is the contraction of the bladder muscles during the filling phase. In children with overactive bladder, the urge to pee comes on suddenly. Even if there is no toilet nearby, they pee at the last moment. At the same time, they feel the urgent need to pee and pee very little.
- Dysfunctional voiding: Abnormal contraction of the voluntary sphincter (muscles around the anus) muscles during voiding, often with an overactive bladder. It is considered to be acquired and may result in complete loss of bladder function. Residual urine remaining in the bladder after voiding, urinary tract infection, and leakage of urine back to the kidney are common accompanying conditions.
- Underactive bladder: These children have less bladder contraction needed to urinate. Bladder capacities are more than they should be. In general, these children go to the toilet less than 3 times a day.
- Delayed urination: Some children; to play, to be lazy, etc. delays their urination due to reasons. In children who delay urination, more load is placed on the pelvic floor muscles and the function of these muscles is impaired. This condition is accompanied by problems such as urinary retention in the bladder and urinary tract infection.
- Constipation: Intestines filled with poop compress the bladder and make it uncomfortable.
- Urinary Tract Infections
- Giggle Incontinence: It is a very special condition, it is urinary incontinence when children laugh. Usually these children have weak pelvic floor muscles.
- Anatomical anomalies
- Children with developmental delays or autism may take longer than their peers to gain normal bladder control.
What tests and evaluations should be done for daytime urinary incontinence?
For the child with daytime wetting, the doctor will first perform a detailed history and physical examination to discover if the wetting is a sign of a medical condition. The doctor will ask the family and child questions about urinary incontinence, such as when and how often. As part of the physical examination, the child's abdomen, rectum (breech), spine, and genitals are examined. If necessary, the child's urination pattern is monitored. Depending on the results of the physical exam, other tests may be ordered, such as:
- Urinalysis, urine culture and susceptibility testing if bladder or kidney infection is suspected.
- Ultrasound, cystoscopy, intravenous pyelogram or voiding cystourethrogram if birth defects in the urinary system are suspected. (Daytime wetting may be associated with problems in the development of the urinary system.)
- Urodynamic study if a lack of nervous system control of the bladder is suspected.
- All these tests may be normal. At the same time, pelvic floor physiotherapists should evaluate the function of the pelvic floor muscles. The function of the pelvic floor muscles cannot be determined by the above tests. For this, EMG evaluation with manual or surface electrodes on the muscles of the pelvic floor is required.
How do we treat urinary incontinence as Tuğtepe Children's Bladder-Intestinal Disorders Center?
After evaluating the pelvic floor muscles, we determine the treatment program individually. In our treatment, we consider the pelvic floor and all the muscles associated with the pelvic floor. Our treatment program includes many different processes such as manual therapy, diaphragm breathing, exercises, pelvic floor exercises, and biofeedback. We play computer games by using the child's muscles with the electrodes we stick around the anus and make the treatment more fun. For example; There is an airplane on the computer screen. The plane takes off when the child squeezes the pelvic floor muscles. It goes down when you let it loose. We are trying to teach the activity of these muscles in a quicker and more fun way with games.
As a result of these treatments, we enable the child to regain the function of the pelvic floor muscles. This is how we teach you to urinate and defecate correctly. Thanks to the pelvic floor muscles that regain their function, children with complaints manage to stay dry both day and night.
What happens if daytime urinary incontinence is not treated?
Daytime incontinence can cause great stress in school-aged children and can negatively affect a child's self-esteem. Therefore, children with daytime urinary incontinence need to be identified and treated as early as possible.
Even drop by drop, the problem of daytime urinary incontinence can lead to much more serious problems in the future. Families say that urinary incontinence will pass after a while, it is a child's incontinence. does not take into account due to reasons such as and postpones the treatment process. Leaving the process to time without correcting the function of the pelvic floor muscles and giving bladder-bowel training may cause urinary incontinence to continue in children.
Only the child with urinary incontinence complained of this complaint over time; It can become a mixed health problem by adding poop incontinence, urinary tract infection, and psychological problems. In children whose treatment is delayed or not treated at all, after a while, urine begins to remain in their bladders, the remaining urine begins to flow back into the kidneys and permanent damage to the kidneys may occur.
In cases such as dysfunctional voiding or underactive bladder, the bladder may completely lose its function in advanced ages and the child may not be able to void properly. The bladder structure may be disrupted. The majority of children with kidney failure start with urinary incontinence and urinary tract infection, which families consider simple. For this reason, a pediatric urologist should be consulted without simplifying the complaint of daytime urinary incontinence.