Urinary incontinence in children

Toilet training, or potty training, is a normal stage in child development, when a child learns to control their bladder and bowels.

Some children experience daytime incontinence — the inability to control when they do or don’t urinate — either because they’ve never mastered full control of their bladder, or because of a regression after a period of dryness.

Urinary incontinence can be frustrating, stressful and embarrassing for your child.

What is urinary incontinence?

More than 90% of children are able to control their bladder during the daytime by the time they are five years old, in some cases it may take longer to fully control when they do and don’t pass urine.

Night-time bladder control usually happens at a later age, and it’s not uncommon for children to wet the bed when they are as old as five or six.

However, for children suffering from urinary incontinence, their lack of bladder control results in uncontrolled leaking of urine. The amount of urine that leaks can vary from a few drops to a full bladder.

Types of urinary incontinence in children

There are several different types of urinary incontinence that can affect your child. They may have one type, or a combination of two or more types.

Daytime incontinence – This is when your child wets themselves during the day.

Night-time incontinence – When your child wets themselves during the night. Many people refer to it as bedwetting.

Primary incontinence – The name used to describe a child’s condition when they haven’t ever fully mastered toilet training.

Secondary incontinence – Refers to when a child has had a period of being able to fully control their bladder, but then starts to experience urinary incontinence again.

Urge incontinence – This type of incontinence happens when your child experiences a very sudden urge to go to the toilet but is unable to get there before their bladder leaks.

Overflow incontinence – This type of incontinence happens when a child doesn’t empty their bladder properly and so it gets gradually fuller until they start to leak urine.

Stress incontinence – More common in adults than children, but is when leaking happens during coughing, sneezing or exercising.

Urinary incontinence symptoms in children

The most common symptom of urinary incontinence is leaking urine. This may be very small amounts, like dribbles of pee, or much larger quantities of urine.

Children with urinary incontinence may announce that they need to pee with little to no notice, or need to go to the toilet much more frequently. Some may even appear reluctant to drink anything because they are worried that they will wet themselves.

What causes urinary incontinence in children?

There are many different causes of urinary incontinence, which can affect both adults and children alike.

Some of the most common reasons why a child may suffer from poor/no bladder control include:

• structural problems with the bladder, which are often congenital (present from birth)
• health conditions that affect the nerve supply to the bladder, such as spina bifida, which can make it hard for a child to realise that they need to pee
• problems with the muscles supporting the bladder
• an overactive bladder, this is when the bladder sends a signal to the brain to tell your child they need to pee when their bladder isn’t full
• urinary tract infections (UTIs)
• constipation, which can put pressure on the bladder
• an irritated bladder — some drinks, like those containing caffeine or fruit juices, can irritate the bladder and cause incontinence
• avoiding going to the toilet — lots of children are uncomfortable using public toilets and so risk having accidents rather than using them

Diagnosing urinary incontinence

Diagnosing urinary incontinence in children can be a complex process, and involves looking at behaviours as well as physical symptoms.

Initially, our paediatric urologists will discuss your child’s wetting instances, asking questions about whether they have ever been able to control their bladder, when their incontinence started and how often they experience bladder leaks.

Your child will also be given a physical examination where their consultant will feel their bladder through their abdomen to see if it feels hard, or if there are any signs of constipation.

Bladder diary

Before your child’s appointment, you may be asked to keep a bladder diary for them over the course of a few days. This is where you record how much fluid your child is drinking, along with how often and how much urine is passed — accidental or otherwise. They may also ask you to monitor your child’s behaviour around the time that they have accidents to see if there is a pattern — for example, if they are too distracted to go to the toilet.

Bladder function testing

In some cases, your child may be referred for an ultrasound scan of their bladder. This non-invasive imaging test uses sound waves to enable your consultant to see the bladder and assess whether it is working properly.

Some children will be referred for a bladder function assessment. This involves them coming into the hospital as a day case where the paediatric urology team will perform a combination of taking measurements of urine being passed and ultrasound to get an overall picture of your child’s bladder function and control.

Finally, your child’s urologist may suggest a test called a cystoscopy. This is where a small tube containing a tiny camera and light is used to look at their bladder. This is often recommended when there’s no obvious underlying cause for a child’s lack of bladder control and where it’s necessary to see the bladder in more detail.

Urinary incontinence treatment for children

Fortunately, there are a range of treatments for children with urinary incontinence. The cause of your child’s incontinence, and their resulting diagnosis, will determine the best treatment type for them.

For many children, behavioural interventions can cause a huge improvement in urinary incontinence. This may include:

• bladder training
• reduced fluid intake
• being more aware of what they are drinking
• awareness of how the bladder feels
• making toileting habits

If your child’s urinary incontinence is caused by a medical issue, such as persistent urinary tract infections, then medications may be prescribed to help. There are also some medicines that can be used to make your child’s bladder less sensitive, reducing their need to empty their bladder.

Surgery for urinary incontinence in children is rare but may be recommended where there is a physical issue causing their lack of bladder control. For example, injections into the sphincter can help relax the muscles surrounding the bladder to reduce episodes of incontinence, or surgery can be used to increase the size of the bladder if it is too small.

Tips for managing urinary incontinence in children

There are a number of things that you can do to reduce the risk that your child wets themselves. They include:

• reducing the amount of fluid they drink, particularly at certain times of the day. For example, reducing fluid intake before bed can reduce the likelihood that your child will wet the bed
• remove caffeine from your child’s diet. Caffeine is known to irritate the bladder, and can be found in drinks like cola, tea, coffee and energy drinks, as well as in chocolate
• waking your child at set times during the night for them to empty their bladder
• reminding your child to go to the toilet before leaving the house or going to bed