Incontinence and bedwetting in children: what to do?

It is difficult to distinguish between nighttime bedwetting and childhood urinary incontinence, but it is necessary to differentiate:

Childhood incontinence is characterized by wetting that is accompanied by additional or sole daytime symptoms such as frequent urination, holding maneuvers, burning or pain when urinating, a strong urge to urinate that cannot be suppressed, or urinary tract infections. Pediatric urinary incontinence occurs in 15 to 20 percent of children with wetting.

Bedwetting , on the other hand, is the most common form of bedwetting. A characteristic of this is bedwetting in children over the age of five on at least two nights a month. Around 33 percent of five-year-olds still wet themselves at night, with boys being affected twice as often as girls. In 15 percent of those affected, the symptoms resolve spontaneously each year. In the case of night-time bedwetting, the so-called enuresis, a distinction is made between two forms:

• In the case of “primary enuresis” , a constitutional developmental delay in the child is assumed. This form of wetting can also run in families and is probably mainly genetic.
• Psychological causes probably play the main role in “secondary enuresis” . It occurs when the child wets the bed again at night after a dry period of at least six months. In three to four percent of cases, this form of wetting even persists beyond the age of 18. With about 75 percent of all cases, it is about three times more common than childhood incontinence.

However, up to the age of five, the occasional night-time bedwetting is completely normal and nothing to worry about. You should only visit a pediatrician and consult with him about further steps if your child still wets the bed frequently afterwards.

What are the causes of childhood incontinence?

There are several causes of childhood incontinence:

• A small bladder capacity, bladder irritation, bladder emptying disorders or a so-called lazy bladder (result of a long-term avoidance of going to the toilet)
• ADH deficiency (hormone in the pituitary gland)
• deep sleep
• family predisposition
• excessive drinking
• breathing disorders
• Congenital anatomical disorders such as abnormal openings of the ureter
• Neurological disorders such as tumorous and inflammatory diseases of the nervous system

Psychological factors can also be a trigger: especially in stressful situations during toilet training in the third year of life, anxiety can lead to persistent wetting or to wetting again later. Behavioral issues associated with bedwetting include:

• Avoiding going to the toilet
• Stool smearing or faecal matter
• aggressions
• Chewing finger nails
• restlessness and sleep disturbances
• Eating disorders and low self-esteem
• inhibition and anxiety
• Pressure to perform and excessive ambition
• Disorders of the parent-child relationship, as well as disorders of the parental relationship

A special form of childhood urinary incontinence, known as giggle incontinence, occurs particularly in young girls. A fit of laughter leads to a loss of control over the bladder muscles and leads to immediate and complete loss of urine. Giggle incontinence usually goes away during puberty.

Treatment options for bedwetting and incontinence

First of all, it is important to clarify in detailed discussions with the pediatrician whether the wetting is caused by a urological, neurological or psychiatric disease. A so-called pee log and a drinking and bladder diary help to analyze the frequency of urination and toilet habits. The amount of urine emptied, the urge to urinate, the wetting events, drinking times, drinking amounts and stool behavior are documented on two consecutive days. This can provide indications of insufficient bladder capacity, excessive nocturnal urine production or incorrect drinking habits.
Treatment options include:

• Urotherapy: The change in drinking and micturition behavior (micturition = complete emptying of the bladder)
• Drugs to increase the bladder capacity and cushion the bladder, to reduce the volume of urine at night or for urinary tract infections
• Alarm systems such as door bells or mats that give an alarm in the event of moisture
• A so-called biofeedback training (bladder and sphincter training)
• A psychotherapy

The chances of success are good if the exact cause can be found. Even so, it may take a year or two before full success occurs. A record of success keeps the children motivated. Contact persons are pediatricians, pediatric urologists and the German Continence Society .

How can you support your child when it wets?

• It is important that you show your child a lot of understanding and patience.
• You should avoid penalties, threats or other persuasions towards the child.
• Give your child the attention they need, but avoid making the illness the focus of everyday family life.
• It is also important to empty your bladder regularly before going to bed.
• At night, your child should have unhindered access to the toilet, which also includes good lighting that they can operate independently.