Incontinence in Children

Incontinence is the involuntary release of urine and faeces. It can affect people of any age or gender and can be the result of many different causes. There are physical and cognitive disorders that cause incontinence making every case different.

While incontinence is more common in people aged 50 and older, children five and above can also experience incontinence. Although it may seem normal for children to have accidents in their day to day, kids who are toilet trained shouldn’t be regularly experiencing accidents. Similarly, incontinence experienced by adults, in children there are many neurological and physical disorders that cause incontinence.

The 3 main types of incontinence that occurs in children are daytime wetting, soiling/ faecal incontinence and bedwetting. In Australia 3-12% of children experience daytime incontinence and 1-3% experience faecal incontinence. Bedwetting is the most common form of pediatric incontinence with one in five kids experiencing this.

By the age of four, children have gained control of their bladder and their ability to visit the bathroom regularly. If a child of this age and older struggle to control their bladder during the day, professional advice may be necessary. This is called daytime wetting or diurnal enuresis.  

Urge incontinence or sometimes known as an overactive bladder is when someone needs to urinate frequently. There are three main causes of this type of incontinence in children, one being the bladder muscles having uncontrollable spasms, which results in urinary urgency, frequency and wetting. An underactive bladder can also cause some issues as postponing toileting, incomplete bladder emptying, and urinary infections can also lead to wetting.

The other cause of an overactive bladder is a condition called pollakiuria. Also known as frequent daytime urination syndrome, pollakiuria is where children from the ages of 3 to 8 urinate frequently. There is no medical reason why this occurs, but it’s suspected that it could be stress related.

Bedwetting is when the bladder involuntarily empties during sleep. This is often the cause of concern for parents as their kids because of the emotional and social effects that bedwetting can have on children like feelings of embarrassment. Bedwetting occurs in children aged 5 and above who are generally dry throughout the day and night.

There are three common causes of bedwetting in children. The first is the child’s inability to wake up each day with a full bladder, which could be due to the bladder capacity. The second common cause of bedwetting is the bladder being overactive at night and unable to store urine. The final cause could be that the kidneys are creating large amounts of urine that’s unable to be stored in the bladder overnight.  

Faecal incontinence is when a child empties their bowels somewhere other than a toilet and because they are normally toilet trained from 3 or 4 years old onwards, regular accidents or the inability to be toilet trained after this age may indicate incontinence.  

Most cases of faecal incontinence in children are because of the large intestine not completely emptying, resulting in constipation for the child. Constipation is very common in children and can affect 25% at one time. If this issue is not treated or recognised, bowel actions may become less frequent and harder for the child to pass, resulting in soiling.

Constipation is the most common cause of faecal incontinence in children but there are some other reasons this occurs. Children may not feel the need to release their bowels while playing or they may not have access to a toilet when they feel the urge to go. Some children might associate pain to bowel movements and will avoid going to the toilet as a result. There are some physical conditions that can cause faecal incontinence.

When examining the impacts of incontinence on children, “it’s important not to forget about the impact that it can have on the whole family”, says Bunzl Australia and New Zealand’s National, Clinical and Governance Manager, Lesley Barton.

If a child is experiencing incontinence, they may feel socially isolated or feel like they are different from other kids. Managing incontinence as a child can lead to a reduced quality of life and self-esteem. This is why it’s important for parents to be involved in the management which is often overlooked when there is a lack of understanding about the condition. Providing information about pediatric incontinence can help parents to be more involved and know what they are looking for if their child begins to experience symptoms of incontinence.

Parents, guardians and carers will inevitably be affected by their child’s change in behaviour and want what’s best for their child, especially during their formative years.

The first tip that should be used by parents and carers is to pay attention to your child’s bowel and bladder behaviour. Keeping a diary and asking questions like these, can help you analyse your child’s toilet behaviours:

• How often is my child going to the toilet?
• How much does my child drink every day?
• What fluids is my child drinking?                           
• How often is my child releasing their bowels? Does it seem difficult for them to do so?
• How often is my child soiling or wetting themselves? What happens when this occurs

If after monitoring your child, you think they need assistance reach out to healthcare professionals who will examine why this is occurring. Professionals will try to determine why your child is wetting themselves frequently during the day.

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A physical examination, blood and urine tests, x-ray or ultrasound will be done to make sure there are no issues with your child that may impact their ability to pass urine and faeces. The results of this will vary for each child but there may be medications like laxatives or urine reducing tablets that can be prescribed by a doctor to help manage incontinence.

Most cases of pediatric incontinence are temporary and may just need management. This can work cohesively with toilet tactics and continence aids, designed to be discreet and help those living with incontinence continue their day without worrying about spills and leakages.

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Authored by: Despina Moshopoulos