Tips and Guidance on Managing Urinary Incontinence in Children

Looking after a child with incontinence can cause many practical and social problems. As a child is taught toilet training at a young, it can be confusing when they become incontinent later in life.

Life can easily start to revolve around managing a child’s incontinence. As researcher David Wilkin asserts, “for families of older children, life inside and outside the home often revolves around the problems of changing nappies, washing, getting rid of smells and finding toilets”. A child’s quality of life can also be severely affected by incontinence. A study in 2007 found that social situation, self-esteem and self-confidence were affected greatly by incontinence. Many of these children are born with mental or physical impairments, however in many cases there are other treatable causes of urinary incontinence in children.

Incontinence at Night

The National Association for Continence claims that most children should have achieved urinary control during the night by the age of 6. If your child is 6 or older and has no known condition that could be causing bedwetting, you are advised to speak to a professional. If you notice your child is wetting the bed (Nocturnal Enuresis), the most likely causes for this are nocturnal polyuria and decreased bladder storage during the night. Nocturnal polyuria is a syndrome where the usual day to night ratio of urine production is altered. This can often be caused by having a poor sleeping pattern. In some cases, a child’s body is not producing enough of the antidiuretic hormone. This hormone is designed to slow down the production of urine at night. A child’s body is designed to produce more of this hormone at night, however in children with Nocturnal Enuresis, this is often a problem. Monosymptomatic Enuresis Nocturia is another common cause of Nocturnal Enuresis, in which a child has an impaired ability to wake up when the bladder is full. This can be due to impaired or absent perception of fullness during sleep, and an imbalance between bladder capacity and nocturnal urine production. In some cases, children can have another medical condition causing this, therefore it is important to take them to a Doctor to establish the cause.

What To Do

A calendar of dry and wet nights should be kept for self-monitoring and motivation. Track whether your child has had an accident each night to establish any patterns related to lifestyle or their diet. Alarm treatment or desmopressin and motivation are the most popular treatment options that Doctors suggest. Using an incontinence alarm is also recommended to train a child to wait until the morning or walk to the bathroom. This method is based on the use of electronic devices which sense moisture and trigger an alarm connected to the device. You should also see a Doctor to outline whether your child has a lack of the antidiuretic hormone, which means they can require the synthetic version known as vasopressin. Studies have shown that 70% of patients respond to desmopressin. Finally, motivation has been shown to be effective in helping children stay dry. Reward your child with verbal encouragement or rewards when they have a dry night.

Incontinence in the Day

Daytime urinary incontinence in children is often caused by functional problems, meaning the bladder has properly formed. These causes can be factors such as constipation or not drinking enough water. Children sometimes deliberately hold in urine for long intervals. In a child’s mind, toileting can seem boring or a child may find something more interesting to do, which can lead to overfilling. However, a small number of children do have an underlying medical reason for daytime urinary incontinence. It is important that you take them to a GP to ensure they do not require surgery or medication. In some cases, a urinary tract infection can be the cause for leakages.

What to Do

It is recommended that consider physical therapy and lower urinary tract rehabilitation for your child. This can include age-appropriate education, biofeedback, behavioural modification and performance of “roll for control” exercises. A study in 2008 followed an 8-year-old girl who was referred to for physical therapy with a diagnosis of pelvic floor muscle hypertonus and dysfunctional voiding. Normal levels of voiding frequency occurred by the third therapy session, with a complete continence occurring by the eleventh therapy session. When daytime wetting is not caused by a serious condition, over-the-counter medicine or counselling should be considered. In some cases, surgery can be considered if these methods are unsuccessful. If you are suspicious your child has a urinary tract infection, take them to a paediatrician for this to be appropriately treated.

Although some treatment methods for daytime and night time leakages differ, there are some tips that every parent needs to follow. If you notice your child is leaking, make sure you put the following tips into action:

Find a Comfortable Protective Product

When looking for a protective product, you are looking for something to make your child feel confident and reassured. Choosing a product with the right absorption is vital in ensuring they have the best quality of life. Many products contain odour neutralising technology, which can be invaluable. Odour can raise suspicions and make children feel self-conscious and humiliated. Mattress protectors are another great way to protect your child’s bed from an accident.

You can read our Product Guides Section for advice on choosing protective products.

Watch Your Child’s Diet

Just because your child has incontinence doesn’t mean they are never allowed to eat chocolate or drink a fizzy drink. However, ensure this isn’t in excess. Try and reduce the amount of sugar and caffeine in their diet, as these are common bladder irritants. Encourage regular fluid intake during the day, as dehydration can further irritate the bladder. Fruits, vegetables and soups contain fluids in addition to liquid drinks. Ensure you also minimize your child’s fluid intake 1-2 hours before sleep to reduce increased nocturnal urine production.

Be Proactive for Overnight Trips

Try and ensure your child is comfortable and confident when they stay away from home at sleepovers and weekends away. You could invest in a washable sleeping bag for your child, for example. Incontinence should not have to impact a child’s social life. If your child has been prescribed over the counter medication, it is a good idea to let them take this on their trip to avoid embarrassment.

Language Is Everything

Using the correct vocabulary is surprisingly important when talking to children about their products. If your child is of older age, try and avoid phrases such as “nappy” or anything that may make them feel babyish. Using motivation for both day and night time incontinence has been proven to be effective if the leaking is not caused by a serious medical condition. Make sure you reward them for dry nights by treating them or providing mental encouragement. However, always avoid punishing or blaming your child for incontinence. In a new study, children who we punished for wetting were shown to be more likely to be depressed and had worse overall quality of life overall compared to bed wetters who were not punished.