Urinary Incontinence (Daytime)

Key Messages

• Urinary incontinence, defined as day wetting in a child over 5 years of age that occurs more than once per month for more than 3 months, affects 1 in 7 children aged 4 years and 1 in 20 children aged 9 years.
• It usually does not have an underlying structural or neurological cause.
• The most common functional causes include voiding postponement, overactive bladder (OAB), underactive bladder, and dysfunctional voiding.

What to Do

Investigate

• taking a detailed history of urinary symptoms, any night time symptoms, voiding patterns, and history of constipation.
• Examine the child’s growth, blood pressure, abdomen, lumbar spine, neurology, and genitalia.
• Perform urine analysis
• renal tract ultrasound with post void residual* to look for structural causes.

*high post void residual bladder volume indicate incomplete bladder emptying, which may mean anticholinergics such as oxybutinin are contraindicated

Manage and Treat by encouraging behavioural modification like increasing fluid intake, avoiding bladder irritants, and treating co-existing conditions like constipation and urinary tract infection

active bladder training, which involves scheduled voiding (every 2-3 hours while awake), double voiding, avoiding holding maneuvers, and teaching the child to fully empty their bladder. This process aims to improve bladder control and decrease the frequency of incontinence.

Provide the parents with relevant information and support eg ERIC website (see below)

When to Refer

• An anatomical abnormality is suspected (e.g. continuous wetting)
• Urine analysis is abnormal
• No improvement is seen after 3 months of active bladder training
• Giggle incontinence symptoms are not improving with age
• Underactive bladder symptoms are not improving after 3 months of aggressive treatment of constipation and voiding training
• Our local Paediatric enuresis service will only take referrals for nighttime wetting

Useful Resources

-ERIC: Children’s Bladder and Bowel Charity

-CUH Patient Information Leaflet on Bladder and Voiding problems in children

-‘Bedwetting’ specific CUH Information Leaflet

Acknowledgements

Checked by Dr Cesar and Dr Shute. Birmingham Childrens Hospital Paediatric Outpatient Guidance