What is Urinary Incontinence?
Urinary incontinence is a very common symptom, which Paediatric Urologists investigate. A thorough understanding of the development of the urinary tract and its function during childhood is essential in rationalising the causes of incontinence.
Daytime continence develops during the second and third years of life, at the time of potty training. At that point, the child is able to voluntarily control when he goes to the toilet, and this independence of nappies signals an important part of urinary tract development. Children who subsequently go on to ignore the natural signals of their bladders and resist going to the toilet, may develop what we call dysfunctional voiding, and this leads to a bladder which is difficult to control, with frequent episodes of wetting in quite older children.
The treatment for this is a combination of investigation to assess the underlying causes, medication which may include antibiotics for urinary tract infection, and medication for co-existent constipation, as well as agents to dampen down an overactive bladder. Helping the child and parent to understand the reasons why wetness occurs goes a long way in helping to resolve the issues, though this may take some time.
Other severe congenital anomalies may account for daytime wetting, and a subtle form of spina bifida may be an underlying cause. In addition, structural abnormalities of the urinary tract often have to be ruled out.
Nighttime wetting is very common and unlike its daytime counterpart, and its tendency to occur in isolation, may not be associated with any abnormality of the urinary tract.