incontinence treatments for children

by Diane K. Newman, RNC, MSN, CRNP, FAAN

Treatment is directed toward:

Increasing bladder capacity.
Increasing awareness of signals from a full bladder.
Increasing the ability to respond to a bladder contraction by using the outer sphincter muscle to withhold urine (pelvic exercises.)

Diet modification

Diet modification, which is especially helpful after dinnertime, involves the elimination of bladder irritants such as foods and drinks that contain caffeine. Children should eat, drink and void regularly during the day, abstain from drinking too much in the afternoon and evening, and experience relaxed routines at bedtime. Parents should monitor the child’s foods and evening snacks for items that contain bladder irritants. Some children with an allergy to milk, for example, will improve their bed-wetting problem by eliminating afternoon and evening milk from their diets. It is also important to regulate a child’s bowel function as most children with bladder problems also experience bowel disorders, usually constipation.

Behavioral therapy

Behavioral therapy is the most often recommended treatment for bed-wetting. The first step is to teach the child about normal bladder function in order to generate interest in his or her problem. The next step is bladder rehabilitation, with a goal toward increasing the amount the bladder can hold. The child is taught how to void in a relaxed position in order to empty the bladder completely. This is especially important in children who have any of the bladder disorders described in the Table. As treatment for most of these disorders, the child is taught how to relax the pelvic floor muscle.

Charting the number of the child’s daytime trips to the bathroom and the time he or she goes to bed is also important. Children with urge incontinence may need to be on a timed voiding schedule where voiding intervals will be gradually increased as soon as the urgency attacks disappear. Children with dysfunctional voiding may have to learn how to decrease the intervals between voiding. In any case, the child is told to void prior to going to bed.

Pelvic muscle exercises

Pelvic muscle exercises are also helpful and include teaching the child to interrupt the urinary stream by tightening his or her sphincter muscle. In children with urge syndrome or dysfunctional voiding, emphasis is placed on relaxing these muscles. Biofeedback therapy and other techniques may also be used.

Your child should be taught to always get up and use the toilet if he or she wakes up during the night for any reason. As with all individuals in behavioral training programs, the child must take responsibility for his behavior and, as part of the therapy, a child should be asked to change his own bed linens.

Moisture alarm systems

Moisture alarm systems that wake the child once wetting begins are the most effective treatment. Bed-wetting alarms gradually train the child to wake up before the wetting occurs. Alarms and moisture-sensing pads can be purchased through drugstores, medical supply stores, mail order catalogs, through Sears (Lite-Alert® Alarm and Wee-Alert® Alarm) and through J.C. Penny Co. (Wet Alarm®) and cost between $45 and $100. The SeekWellness store carries WetStop2.

The alarms contain a sensor that attaches either to the child’s underwear or to the pad on the bed that will cause the alarm to buzz or vibrate once the child begins to urinate.

You may also try setting an alarm clock to ring every three to four hours that wakes the child to urinate. Unfortunately, many children sleep right through the alarm and it wakes the parent instead. Also, many children are frightened when they wake up in a dark room at night. Night-lights remind a child to get up and use the bathroom and allow her to easily see her way there. Alarm therapy has a high dropout rate as many children and parents do not use them properly. Consequently, alarms are most successful in children who have supportive and tolerant parents.

Drug treatment

Drug treatment for bed-wetting may be an option. Effective medications include:

Demopressin (DDAVP) is a naturally occurring hormone (antidiuretic hormone or ADH) that decreases the amount of urine the body produces at night, thereby lessening the chance of bed-wetting. Research has shown that children who bed-wet may have a deficiency of this hormone and, as treatment, it is the most successful of the drug therapies. Demopressin has very few side effects.
Imipramine (Tofranil) is an anti-depressant drug that reduces the bladder’s irritability and tightens the sphincter. Also used in adults with incontinence, this drug is effective while it is being taken, however, once the drug is stopped the bed-wetting may resume. Furthermore, this drug has many side effects.

If the child has not stopped bed-wetting while using either an alarm or a medication, a combination of the two treatments, especially an alarm with Demopressin, may be successful. In bladder disorders such as urge syndrome, drug therapy that relaxes the bladder (detrusor) muscle is helpful.

References

Newman, DK. Managing and Treating Urinary Incontinence. Health Professions Pr. 2002.

Last updated: July 2006