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Managing Childhood Incontinence

How to know when your child needs more help 

One of the many challenges for parents of young children is helping them transition from nappies to “big kid” pants and there can be many accidents along the way but for some the challenges persist. When do you know your child’s development needs further support and what can you do?  

Childhood Development and Incontinence

Although the age can vary, most children gain control of their bladder and bowel by the time they are 3-4 years old. However, as many as 17–20% of school aged children will experience daytime bladder incontinence issues, while 8–20% of 5 year old children have nocturnal enuresis (night wetting)1 and 1-3% of children have bowel management problems2.

While childhood incontinence is not uncommon, it can be very distressing for parents and have a significant negative impact on a child’s psychosocial well-being and quality of life3, so diagnosis and successful treatment are both important and make a big difference.

 

How do I know if my child is incontinent, and why is it happening?

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.

How can I support my child?

Once you have identified your child is experiencing incontinence the first thing to understand is that it’s not due to any willful act or poor toilet training, unfortunately there are some common misconceptions around urinary incontinence that can cause your child further distress.

It is important to realise that bladder and bowel incontinence is NOT caused by:

  • the child being young for their age
  • laziness
  • naughtiness or bad behaviour
  • attention seeking or a rebellious nature
  • drinking too much or drinking after dinner
  • or, poor toilet training

Although accidents may cause emotional distress, they are not usually caused by it and while a child may appear to be unaware it has happened, or not want to change it is not a sign of not caring - they are usually very deeply upset so it is important to seek help and professional advice on treatment options for all forms of incontinence.

 

What help can I get for my child?

Unresolved bladder or bowel problems should be addressed by a health professional such as your family doctor or by seeing a continence nurse. Other health professionals who can also assist are a continence physiotherapist, psychologists and occupational therapists.

Before taking your child to an appointment it is helpful to take note of his of her bladder and bowel patterns over a few days including:

  • How often does your child go to the toilet?
  • How often is your child wetting?
  • What happens when they wet?
  • How often do their bowels open and is it difficult for your child?
  • How much does your child drink?
  • What type of fluids is your child drinking and when?

When you visit a health professional he/she may investigate through:

  • a detailed medical history
  • a urine test to exclude infection of the urinary tract (bladder and kidneys)
  • a physical examination of the spine (back) and the bladder opening to exclude any nerve involvement or structural problems
  • an abdominal examination which may help exclude constipation, and
  • an ultrasound of the urinary tract.

A treatment plan can then be created to help get your child’s incontinence under control and help them regain their confidence. This will general start with conservative therapy options focused, while in some instances further referrals may be recommended.

If you require products to help with managing childhood and teen incontinence then ConfidenceClub supplies a range of products designed specifically for the size gap between babies and adults.

Browse Products for Juniors and Teens >

Further Resources and Support

Further information and help can be obtained through contacting the Continence Foundation of Australia https://www.continence.org.au/ or the free helpline 1800 33 00 66.

For teachers who want to know how to support primary aged children by promoting healthy and bladder and bowel habits, and learn how to recognise the signs a child may be experiencing bladder or bowl issues at school the Continence Foundation provide useful online materials you can access here.

 

Sources:

1) Nankivell, G; Caldwell, P; Paediatric Urinary Incontinence, Australian Prescriber, 2014; 37; 6 : 192-195.

2) Continence Foundation of Australia – Soiling; https://www.continence.org.au/pages/soiling.html

3) Von Gontard A, Baeyens D, Van Hoecke E, Warzak WJ, Bachmann C. Psychological and psychiatric issues in urinary and fecal incontinence. J Urol 2011;185:1432-6.

4) Continence Foundation of Australia – Day wetting; https://www.continence.org.au/pages/day-wetting.html

5) Continence Foundation of Australia – Bedwetting; https://www.continence.org.au/pages/bedwetting.html