Loss of Bladder Control in Children

Loss of bladder control, also known as incontinence or enuresis, is fairly common in young children. Approximately 7 percent of 5-year-old boys and 3 percent of 5-year-old girls experience problems with bladder control. Children with parents who had childhood incontinence are five to seven times more likely to develop enuresis. The condition is usually no cause for alarm and often disappears on its own. By age 18, only 1 percent of individuals are incontinent.

Types

• There are four types of childhood incontinence. Primary enuresis refers to children who have never obtained bladder control. Secondary enuresis refers to children who have relapsed after obtaining control for at least six months. Nocturnal enuresis or nighttime incontinence occurs only during sleep and is more common in boys. Diurnal enuresis or daytime incontinence happens when the child is awake and occurs more often in girls. Daytime incontinence is less common and usually disappears sooner.

Causes

• Nighttime incontinence is usually the result of small bladders, heavy sleeping or failure to notice the signals sent by a full bladder. It may also be due to a lack of ADH, a hormone that slows down the production of urine at night. These issues usually resolve with maturity. Sometimes bed wetting is caused by obstructive sleep apnea, which is typically due to inflamed tonsils or adenoids. In rare cases, a blockage in the bladder or urethra or nerve damage associated with spina bifida may be the cause of nocturnal enuresis. Daytime incontinence is often caused by urinary tract infections but caffeine or food allergies can also trigger this condition. Occasionally, daytime wetting is due to abnormalities in the kidney or bladder.

Diagnosis

• To be diagnosed with enuresis, a child must be at least 5 years old. Loss of bladder control must occur at least two times every week for three months. If a pre-existing medical condition or medication has caused the behavior, it is not considered enuresis.

Treatment

• Behavioral therapy is the most effective treatment for incontinence. Children are taught exercises to strengthen bladder muscles and to pay closer attention to the body's signs of a full bladder. Some children wear alarms to detect and signal the first sign of wetness. Drinking less before bedtime, waking during the night, going to the bathroom on a regular schedule and avoiding caffeine can also help. In some cases of nocturnal enuresis, a synthetic version of ADH is used. Medications such as imipramine or anitcholinergics may also be prescribed to calm bladder muscle. However, relapses often occur when these drug treatments are discontinued. Hypnosis has been effective in some cases. Acupuncture and massage have also been used but results are inconclusive.

Prognosis

• Most children outgrow incontinence naturally. For others, behavioral therapy is successful 75 percent of the time. Drug treatments are more effective when combined with behavioral therapy.