What is the treatment for urinary incontinence in children?

Treatment of Urinary Incontinence in Children

The first-line treatment for urinary incontinence in children is urotherapy, which includes behavioral modifications, timed voiding, and proper fluid management, with additional therapies such as alarm therapy and desmopressin for nocturnal enuresis based on the specific type of incontinence. 1, 2

Types of Urinary Incontinence in Children

Understanding the type of incontinence is crucial for effective treatment:

1. Monosymptomatic Enuresis (MEN): Nighttime bedwetting without daytime symptoms
2. Non-monosymptomatic Enuresis (NMEN): Nighttime bedwetting with daytime symptoms
3. Daytime Incontinence: Urinary leakage during waking hours

Initial Assessment

Key elements to assess:

• Voiding patterns (frequency, urgency, holding maneuvers)
• Presence of daytime symptoms
• Frequency of bedwetting episodes
• History of UTIs
• Bowel habits (constipation is present in 33-56% of cases)
• Family history (44-77% of children have enuresis when one or both parents were enuretic) 1
• Post-void residual measurement for incomplete emptying 3

Treatment Algorithm

1. Standard Urotherapy (First-line for ALL types)

• Behavioral modifications:

  • Regular voiding schedule (every 2-3 hours)
  • Proper voiding posture
  • Complete bladder emptying
  • Maintaining a voiding diary 1

• Fluid management:

  • Liberal fluid intake during morning/early afternoon
  • Minimizing evening fluid intake
  • Avoiding bladder irritants (caffeine, citrus) 1, 3

• Constipation management:

  • Dietary fiber
  • Adequate hydration
  • Stool softeners like polyethylene glycol if needed 1, 3

• Education and motivation:

  • Calendar tracking of dry/wet nights
  • Setting realistic goals
  • Monthly follow-up 1

2. Specific Treatments Based on Type

For Monosymptomatic Nocturnal Enuresis:

1. Enuresis Alarm Therapy (most effective long-term solution):

   • Recommended for children aged 6+ years
   • Conditions the child to wake when bladder is full
   • Requires 2-3 months of consistent use
   • Success rates of 70-80% 4, 1

2. Desmopressin:

   • Reduces urine production at night
   • Faster results than alarm therapy
   • Best for children with nocturnal polyuria
   • Can be used temporarily for social situations (sleepovers) 4

For Non-monosymptomatic Enuresis:

1. Treat underlying causes first:

   • Address daytime symptoms
   • Manage constipation
   • Treat UTIs if present 1, 5

2. Anticholinergics (for overactive bladder):

   • Oxybutynin for detrusor overactivity
   • Dosing based on child's weight
   • Monitor for side effects (dry mouth, constipation) 3, 6

For Daytime Incontinence:

1. Specific urotherapy:

   • Biofeedback training
   • Pelvic floor exercises
   • Timed voiding 7, 2

2. Pharmacological options (if urotherapy fails):

   • Anticholinergics for overactive bladder
   • Alpha-blockers for outflow obstruction 3

When to Refer to a Specialist

Referral to a pediatric urologist is indicated for:

• Children with primary enuresis refractory to standard treatments
• Suspected urinary tract malformations
• Recurrent UTIs
• Neurological disorders affecting bladder function
• Continuous incontinence or weak urine stream 1, 8

Important Considerations

• Age: Active treatment typically begins after age 6 years, as spontaneous resolution occurs at 14-16% annually 1
• Comorbidities: Address psychiatric/behavioral issues concurrently
• Parental support: Essential for treatment success
• Patience: Treatment requires time and consistency

Treatment Success Measures

Success is defined as:

• ≥50% reduction in wet nights
• Improved quality of life
• Reduced UTI recurrence
• Normalized voiding patterns 3

Remember that urinary incontinence in children is often a developmental issue that improves with age and proper management. The psychological impact on the child should be considered throughout treatment.