Urinary Incontinence

Normal Urination Mechanism

Urine is stored in the bladder, which expands as the amount of urine increases. When the stretch reaches a certain point, the bladder nerves send signals to the brain. In response, the brain signals that the bladder is full. The process involves contracting the bladder muscles, which press the urine out through the urethra.

Urinary Incontinence

Urinary incontinence, also known as enuresis or bedwetting, is the inability to control the flow of urine, particularly in children over the age of four. It can lead to anxiety for both children and their families, as well as discomfort and embarrassment.

Urinary Incontinence Facts

• Full maturity of the bladder, allowing for urine control, typically occurs between the ages of 3 and 5 years, with some variability.
• Daytime control usually develops first, followed by nighttime control.
• Urinary incontinence before this age is considered normal and should not be labeled as urinary incontinence until after the age of five.
• Urinary incontinence is more common in boys.

Types of Urinary Incontinence

• Nocturnal urinary incontinence: It is the inability to control urine during sleep at night.
• Daytime urinary incontinence: It is the inability to control urine during the day.
• Urinary incontinence through day and night: It is the inability to control urine both during the day and at night

Bedwetting is also divided into two types:

• Secondary Enuresis: Inability to control urine after a period in which the child had successfully managed control for 6 to 12 months.
• Primary Enuresis: Inability to control urine from birth.

Causes of Urinary Incontinence

Urinary Incontinence can be caused by a dysfunction which may include:

• Significant increase in the body's urine production, especially at night.
• Not producing enough ADH (antidiuretic hormone that reduces the amount of urine the kidneys produce at night)
• Small bladder in children (due to incomplete development)
• Defect in neuromuscular coordination, which leads to the spontaneous flow of urine.

Diagnosis of Urinary Incontinence

• Clinical examination
• Laboratory Tests
• Medical Imaging

Treatment of Urinary Incontinence

There are simple, basic but important steps to start the treatment journey:

• Boost self-confidence by using verbal encouragement, morale-boosting, and rewards as treatment progresses.
• Avoid excessive blame, verbal or physical abuse, and do not exaggerate the situation.
• Involve the child in the treatment process early on
• Exclusion and treatment of organ-related causes of bedwetting

Changing behavioral habits by training the child to do the following:

• The child should be encouraged to change their clothes independently, with (absorbent cotton underwear) provided and kept within easy reach. It is important to avoid using diapers, as this may make the child feel like they are reverting to childhood habits.
• Go to the bathroom and empty their bladder before bed. Ensure easy access by providing adequate lighting and keeping the bathroom close to the bedroom.
• Avoid drinking fluids for at least two hours before bedtime, especially carbonated and caffeinated beverages.
• Wake the child up at least once during the night after 3 to 4 hours of sleep.
• Strengthen your bladder muscles during the day by drinking plenty of fluids and practicing control over the urge to urinate before going out.
• Try to reduce the chances of deep sleep at night by regulating daytime sleep, so that the child gets a nap of between one and two hours.

Use of bedwetting alarm

It is a small sensor attached to the underwear while sleeping. When the first drops of urine are detected, it emits an alert sound or vibrations, or both, waking the child and allowing them to control their bladder until they can reach the bathroom.

Drug therapy

• It is considered the final stage of treatment and is only used in difficult cases.
• This approach is intended for older children, specifically those aged 7 and above.
• Drug treatment is not a permanent solution, but it serves as a temporary measure to stop bedwetting, with the possibility that the issue may return, either as it was or to a lesser extent.
• Some medications used to reduce nighttime urine production include antispasmodics, which treat bladder spasms, as well as certain antidepressants.