A guide for families and children with daytime incontinence
What is daytime urinary incontinence and how often does it occur?
Urinary incontinence is present in a significant proportion of children. Urinary incontinence can occur at night, during the day, or both. Daytime urinary incontinence is encountered in 6% of girls and 4% of boys who have reached the age of seven.
What are functional voiding disorders?
After excluding structural and neural causes, urinary incontinence is usually due to a disorder in bladder storage and/or emptying functions. This group of diseases is generally referred to as "functional voiding disorders". These disorders are:
- Urge syndrome and urge incontinence: It is characterized by the need to urinate frequently and suddenly during the day. During this time, the child resorts to some urinary retention maneuvers (squatting, crossing the legs, pressing the perineum, squeezing the penis, etc.) to prevent urinary incontinence. In this way, it tries to prevent urinary incontinence by contracting the pelvic floor muscles. If these inhibitions are not sufficient, urinary incontinence occurs, which is called urge incontinence. Typically, complaints increase in the afternoon and evening hours when attention is reduced. Urination is normal and there is usually no residual urine after voiding. Increased pelvic floor muscle activity as a result of squeezing leads to delayed toileting and constipation. Due to occasional stool leaks due to constipation, soiling may occur in underwear.
- Dysfunctional voiding: It is a condition that occurs due to contraction of the urethral sphincter and pelvic floor muscles during voiding. The most important difference of this picture from the impingement syndrome is that the normal voiding pattern is now impaired. In these children, voiding becomes intermittent, and there is usually residual urine left behind after voiding. In the later stages of this picture, the bladder muscle begins to lose its strength because the child is constantly trying to hold urine. In the uroflowmetry, voiding pattern in the form of fluctuations (staccato voiding sample) and increased EMG activity are observed in the pelvic floor electromyography.
- Vaginal voiding: It is especially seen in fat girls who pee with their legs closed. Urine first fills the vagina, then the underwear gets wet when the child stands up.
- Giggle incontinence: In this condition, which is seen almost entirely in girls, the bladder empties suddenly and completely while laughing. The reason is not entirely clear.
How is the treatment of dysfunctional voiding done?
- Medication: If the event that triggers dysfunctional voiding is thought to be urge syndrome, anticholinergics can be added to the treatment.
- Urotherapy and biofeedback: The most important step in the treatment of children with dysfunctional voiding syndrome is to reduce the increased pelvic floor muscle activity. If the child has a habit of keeping his urine waiting, this should be tried to be broken. It is very important to gain the habit of urinating every two hours. If urine remains after voiding, the habit of double urination should be added to timed urination. In other words, a 2 min. after the child gets up from the toilet. Then he should go back to the toilet and pass the remaining urine. The child should sit on the toilet with his legs spread out, without squeezing himself, and his feet must touch the ground or if he is not tall enough, he should put a step under his feet. In the treatment of children with dysfunctional voiding, this method, called biofedback therapy, in which the child is taught to keep the pelvic floor and the muscles that hold the urine, and to keep these muscles loose during voiding, has been reported to have success rates of up to 80%. In the presence of recurrent infection or reflux, preventive antibiotics should be added to the treatment. You can find more information about the biofeedback technique and its applications in children, in the "Incontinence and Biofeedback" section of this site.