Effective Treatments for Childhood Urinary Incontinence: What to Know - Urology

Dr. Cai Zongyou reply Urology

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Under normal circumstances, by the age of 5 to 6 years, most children can moderately control urination, but a small number of children are unable to do so appropriately, leading to enuresis.
Bedwetting (Enuresis) has troubled countless families and individuals throughout history.
However, there are still deep misunderstandings among the general public regarding bedwetting.
Enuresis is a common condition during childhood.
According to research reports from Taiwan, 15 out of every 100 children aged 5 experience bedwetting, and the average rate among elementary school children is 4 to 6 out of every 100.
What causes bedwetting? Studies have linked bedwetting to the following factors: 1.
Genetic inheritance: If both parents have experienced enuresis, approximately 70% of their children will also experience it; if one parent has experienced it, about 40% of their children will; and if neither parent has experienced it, the chance of their child experiencing enuresis is only 15%.
2.
Small bladder capacity.
3.
Impairment of the brain's arousal system.
4.
Low secretion of antidiuretic hormone at night.
5.
Delayed maturation of the central nervous system.
In fact, according to medical literature, less than 5% of bedwetting cases are due to organ abnormalities, and most cases are treatable.
Pediatric enuresis can be classified into primary enuresis and secondary enuresis.
Primary enuresis refers to a situation where the child has never stopped bedwetting since birth; secondary enuresis refers to a situation where the child has not wet the bed for at least six months to a year and then starts bedwetting again.
Primary enuresis accounts for about 90% of cases, generally with a genetic tendency and related to developmental maturity; secondary enuresis is typically a result of physical illness or psychological factors.
Generally, most pediatricians recommend that parents do not intervene and allow time to resolve the issue, as bedwetting often improves with functional maturity.
However, the natural recovery rate is only 15% per year, and the frustration felt by parents and children makes treatment for bedwetting necessary.
Since bedwetting may resolve naturally, and literature reports that the placebo effect of treatment can be as high as 68%, several methods have been proven effective in treating bedwetting: medication, behavioral modification, and alarm systems.
Parental support, empathy, and patience are fundamental elements for successful treatment; on the other hand, encouragement, feedback, and restoring confidence from physicians are also necessary for the child and their parents.
The choice of treatment method must consider the parents' attitudes, level of cooperation, and understanding of bedwetting.
Since bedwetting is quite common in children under 4.5 years old, treatment is generally only necessary for children over 5 years old.

1.
Medication can be divided into two main categories: one is Imipramine, which has a narrow therapeutic index and toxicity, so parents must supervise their child's intake closely and store the medication securely to prevent serious side effects from accidental ingestion or overdose.
The second is antidiuretic medication (DDAVP), which reduces nighttime urine production to treat bedwetting; generally, this medication has fewer side effects.
When dealing with a child's bedwetting, parents should maintain a calm demeanor and cooperate with the physician's treatment, which is the correct approach.

2.
Urine alarm: This method involves placing a metal-lined urine pad on the child's bed connected to an alarm (bell or buzzer), which activates when even a small amount of urine is detected, waking the child to go to the bathroom and establishing a conditioned reflex.
For children with primary enuresis and no daytime bladder instability, using this method for at least four months can yield a success rate of up to 70%, with a relapse rate of about 30%.
Despite the relatively high relapse rate, this method remains the most effective treatment for bedwetting.
Although this method is more effective than medication, compliance from patients and their families is often lower, as achieving a dry bed typically requires about 16 weeks on average.

3.
Urine retention and sphincter control exercises: The goal of this method is to increase the child's functional bladder capacity and improve control over the urination reflex.
The method for urine retention control involves teaching the child to go to the bathroom when they feel the urge to urinate but to hold it until they can no longer do so.
Sphincter control training involves teaching the child to hold their urine after starting to urinate and then to resume urination, repeating this cycle 3 to 5 times.
After such training, about 30% of children can reduce the frequency of their bedwetting.

4.
Psychotherapy: Psychotherapy is not the first-line treatment for bedwetting but can be valuable for children with secondary enuresis or emotional issues.
If a child experiences symptoms such as shame, depression, or excessive sensitivity due to bedwetting, they should receive psychological counseling.
However, most children do not have significant psychological disorders, and psychotherapy is neither necessary nor beneficial for them.

5.
Hypnotherapy: This method is not widely used, but reports indicate that it may lead to dramatic improvements in treating bedwetting.
One study reported that out of 40 bedwetting children who received hypnotherapy, 31 were cured, and 6 showed significant improvement, with several other studies reporting similar results.
Nevertheless, very few physicians recommend this treatment to patients.

6.
Fluid restriction: Reducing fluid intake before bedtime, such as encouraging the child to urinate before sleeping, may help, especially for those without antidiuretic hormone rhythm, but it is less effective for children with other issues.

General recommendations for treating children with bedwetting include: 1.
Gaining the child's cooperation and motivating them to address and solve the problem.
2.
The child or their parents should keep a record of daily bedwetting incidents.
If there are one or two days without bedwetting, parents should encourage or reward the child, providing tangible rewards to increase the cure rate.
3.
Older children should be encouraged to wash and change their soiled sheets and pajamas themselves.
4.
Children should avoid drinking water after dinner and should urinate before bedtime.
5.
Punishment or humiliation for bedwetting behavior should be strictly prohibited.

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Reply Date: 2007/04/18