Urinary incontinence occurs in children up to the age of 2. Symptoms of urinary incontinence in children may vary depending on the type of incontinence.
How Do We Urine?
The capacity of the bladder in the newborn is approximately 30 ml, this capacity increases approximately 30 ml each year and reaches 400-500 ml in adolescence.
After the age of 2.5, normal urine is started.
For normal urination, the nervous system, muscular system and passageways must be intact. Urine coming into the bladder from the kidney via ureter tubes begins to accumulate.
The bladder muscles relax and begin to store this urine. After reaching a certain volume, it sends a signal to the brain through the spinal cord through the nerve endings and a feeling of urine occurs.
If there is no suitable place to urinate, the brain sends a signal to the bladder and urine is kept by the urine retention mechanism we call the sphincter. The bladder continues to expand for a while.
When going to the toilet, the brain decides that it is a suitable environment to urinate. The bladder detrusor muscles start to contract, while the urinary retention mechanism, which we call the sphincter, relaxes and the bladder empties through the urethra.
How Does Urinary Incontinence Happen? What are the causes?
Children up to 2.5 years of age, during the day and until 4 years of age, keep urine at night. Wetting due to inability to control urine above the age of five is called urinary incontinence in children.
It can be day and night together or just night. If there is only nocturnal incontinence and there are no other symptoms, it is considered only as nocturnal enuresis and can be treated without additional further examination.
If a child over the age of 5 has urinary incontinence both day and night, this is very important and the underlying pathology must be clarified.
In this case, very serious problems such as excessive urine production in the kidneys, storage failure of the bladder, pathologies in the bladder outlet, the presence of congenital valves (posterior urethral valve) at the back of the external administration pathway, spinal neural problems such as tetered cord, brain and spinal cord disorders should be investigated.
How Should Urinary Incontinence in Children Be Evaluated?
The type of urinary incontinence should be determined by taking a very good medical history and physical examination.
Is it night? Is it daytime? Both? Are there any other symptoms? These factors should be investigated.
It is necessary to look at the genital organs, anterior abdominal wall, testicles and body development. Urinalysis, urine culture, and urinary ultrasonography are the first tests to be considered. If there are abnormalities in these, urodynamics, voiding cystourethrography (VCUG), cystoscopy and MRI should be performed.
How Does Urinary Incontinence Affect Children and Family?
Children of this type do not want to stay anywhere other than home, they have a sense of guilt and shame. They think that they are different from other children, they have low self-esteem, are upset, desperate and anxious.
They worry that this situation will never go away. Families, on the other hand, may not care much about this situation, they can accuse the child, have a fear of embarrassment, think that it is psychological and leave the research later.
How Is the Treatment Arranged?
For treatment, first of all, the type and cause of urinary incontinence should be determined. Necessary tests should be done except for nocturnal enuresis and treatment should be started gradually after the cause is determined. If there is constipation, this should be eliminated and fluid intake should be regulated.
Necessary pelvic floor exercises should be recommended, and if there is an overactive bladder, it should be supported with anticholinergic drugs. If there is a neurogenic bladder, it should be treated for the cause. If the bladder capacity is small, bladder enlargement operations should not be avoided after urodynamic examination. The physician, child and family should be in full coordination.
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