Urinary incontinence is defined as involuntary wetting at an inappropriate time and place in a child aged five years or more.
Common daytime urinary incontinence problems4 can be because of:
- An overactive bladder - the child’s bladder has problems holding onto urine resulting in them experiencing urgency (when they say they are bursting) and, sometimes, suffer leakage on the way to the toilet. These children often go to the toilet more than 8 times a day
- An under-active bladder – results in a child not going to the toilet often enough (less than 4 times a day). Sometimes they will have no warning they need the toilet and have accidents when the bladder overfills. Often these children have urinary tract infections.
- Urinary leakage – can occur when the child is in the habit of putting off going to the toilet, causing the bladder to overfill; and
- Incomplete bladder emptying – when a child has not learned to empty their bladder properly, often because they are in too much of a hurry.
Although it is rare for children to have structural problems a medical specialist should manage any child identified as having an anatomical or neurological cause for their incontinence.
Bedwetting (nocturnal enuresis) is classified as primary or secondary. Most children have primary enuresis and have never achieved night continence. Those who have previously been dry for at least six months have secondary enuresis1.
Main causes of bedwetting5 are:
- Poor sleep arousal - An inability to wake in response to a full bladder
- The bladder becoming overactive at night so the child cannot store their urine
- The kidneys making a large amount of urine at night and the bladder not being able to hold the amount of urine being made.
Although there are some illnesses linked to bedwetting most children do not have major health problems.
Soiling2 (faecal incontinence) is the emptying of the bowels in places other than the toilet. It may vary from a 'skid mark' to larger amounts that need to be removed from underwear before it can be washed. Even after a child is toilet trained, there may be occasional accidents with soiling (poo) in the child's underwear.
If a child is unable to be toilet trained or has regular poo accidents after the age of three to four years or if a child has been toilet trained and at a later stage starts to soil they should be medically assessed.
In almost all cases soiling happens because the large bowel is not emptying properly and the child is constipated. Constipation is very common and up to 25% of children will experience it at some time. If it is not recognised and treated, bowel actions may become harder and less frequent. Over time, stretching of the bowel makes it less sensitive, so the child may no longer feel when poo needs to come out and therefore has an accident. It is possible to experience soiling that is soft and runny even when there is hard poo inside the bowel, so parents might not realise that constipation is the underlying cause.
Constipation often occurs because:
- Painful bowel actions may lead to the child avoiding pooing
- The child may not want to use kinder garden or school toilets because of privacy or cleanliness issues
- The child may not be able to access a toilet when they feel the urge to go
- Some children just don't feel the need to go when they are busy with something else
Occasionally there are physiological causes including the bowel not being able to squeeze effectively, or dietary from food allergies but these are not common.