What is the treatment for functional urinary incontinence in female children?

From the Guidelines

The treatment for functional urinary incontinence in female children should primarily involve a comprehensive approach including education, timed voiding, adequate fluid intake, and aggressive management of constipation, with a success rate of up to 90% to 100% with an escalating treatment approach. This approach is based on the most recent and highest quality study available, which emphasizes the importance of initial education and trial of noninvasive methods on initial presentation 1. The initial steps in urotherapy should always involve education of the child/family regarding bladder/bowel dysfunction, timed voiding, adequate fluid intake, aggressive management of constipation and hygiene issues.

Key components of the treatment include:

• Education on bladder and bowel function
• Timed voiding to establish a regular urination pattern
• Adequate fluid intake to prevent constipation
• Aggressive management of constipation, which is usually treated with initial disimpaction with oral laxatives ideally followed by a maintenance phase of ongoing bowel management in conjunction with a toileting program 1
• Correct toilet posture, with buttock support, foot support, and comfortable hip abduction to enable a sitting posture that does not activate abdominal muscles and, therefore, simultaneous co-activation of pelvic floor musculature
• Biofeedback sessions to improve flow rate and teach muscle isolation using perineal EMG surface electrode feedback, with the advantage of requiring fewer total sessions and resulting in quicker return to normal flow pattern 1

It is essential to address behavioral or psychiatric comorbidities concurrently and offer appropriate services to the child/family. Treatment success or failure is measured by many of the same tools initially used, including voiding diaries and flow rate measurements. By following this comprehensive approach, the treatment of functional urinary incontinence in female children can be highly effective, with success rates reaching up to 90% to 100% 1.

From the FDA Drug Label

The safety and efficacy of oxybutynin chloride administration have been demonstrated for pediatric patients 5 years of age and older The safety and efficacy of oxybutynin chloride tablets were studied in 30 children in a 24­ week, open-label trial Patients were aged 5-15 years, all had symptoms of detrusor overactivity in association with a neurological condition (e.g., spina bifida), all used clean intermittent catheterization, and all were current users of oxybutynin chloride.

The treatment for functional urinary incontinence in female children may involve the use of oxybutynin chloride for those aged 5 years and older, as it has been shown to improve clinical and urodynamic parameters in pediatric patients with detrusor overactivity 2.

• Key points:
  • Oxybutynin chloride is not recommended for pediatric populations under age 5 due to insufficient clinical data.
  • Total daily doses ranging from 5 mg to 15 mg have been associated with improvement in clinical and urodynamic parameters.
  • Treatment with oxybutynin chloride tablets has been associated with an increase in mean urine volume per catheterization and a reduction in the percentage of patients demonstrating uninhibited detrusor contractions. However, it is essential to consult a physician to determine the best course of treatment for individual cases of functional urinary incontinence in female children.

From the Research

Treatment Options for Functional Urinary Incontinence in Female Children

• The treatment for functional urinary incontinence in female children typically involves a combination of standard therapy, behavioral therapy, bladder training, physiotherapy, and medical treatment 3.
• Cognitive treatment has been shown to be a key factor in the success of treatment, with cure rates of 39% to 52% in some studies 4.
• Bladder training programs have also been found to be effective, with cure rates of 64.1% to 64.7% for daytime wetting and 51.5% to 17.7% for nighttime wetting 5.

Specific Treatment Approaches

• Standard urotherapy, which includes educating the patient and their parents to promote behavior changes with respect to drinking and micturition, has been shown to be effective in 56% of patients with daytime urinary incontinence 6.
• Pelvic floor muscles training (PFMT) with or without biofeedback (BF) has also been used as an alternative treatment for functional urinary incontinence in children, with similar efficacy to PFMT alone 7.
• Alpha-blockers and neuromodulation may also have a place in treatment, but further research is needed to define their exact indications 3.

Diagnostic Evaluation

• Diagnostic assessment for functional urinary incontinence in children focuses on the clinical picture, is non-invasive, and can be carried out in most healthcare settings 6.
• Urodynamic studies, such as uroflowmetry and pelvic floor electromyography, may be used to detect overactivity of the pelvic floor muscles and to evaluate the upper urinary tract 3.
• A 7-day voiding and bowel diary can also be used to evaluate the child's bladder and bowel habits 7.