Urinary incontinence (enuresis)

Urinary incontinence (enuresis) is the term for accidental urination in children at a point in their development—usually ages 7 or 8 or older—when they should have bladder control. Accidental wetting is common and normal in children ages 8 or younger. Generally, girls develop bladder control earlier than boys do.

Incontinence (enuresis) can be diurnal (during the daytime) or, more commonly, nocturnal (wetting the bed at night). A child who has never mastered bladder control may be diagnosed with primary enuresis, while a child who was toilet-trained but later experiences periods of incontinence may be diagnosed with secondary enuresis.

What causes urinary incontinence?

It is very important that a child not be punished for incontinence. He or she is not at fault for their lack of bladder control. The bladder is a muscle. When a child has urinary incontinence, it may simply be that the muscle is too small, overactive, or prone to spasms that cause the frequent urge to urinate. There may be a delay in the development of the child’s ability to hold urine, or problems with the hormones that regulate urination. Nocturnal enuresis also tends to run in families.

There are many theories about why this condition occurs, but possible reasons include:

• Unsuccessful toilet training
• Poor sleep habits or a sleep disorder
• Nervous and emotional issues
• Infection or abnormalities in the bladder or urinary tract
• Dietary factors, such as the intake of caffeine, carbonated drinks, or citrus fruits
• Effects of medications
• Timing of fluid intake

How is it treated?

The first step is to rule out infections or other conditions that could be causing the enuresis. If a secondary condition is not found, treatment may include bladder training, the use of nighttime alarms to control bedwetting, and/or positive reinforcement techniques. Child and family counseling may be used to determine whether the child is under any particular stress.

Sometimes, when these treatments don’t work, an InterStim device may be an option for your child. The InterStim device is surgically implanted under the skin. It sends mild electrical pulses to a nerve in the lower back called the sacral nerve, which influences the bladder and surrounding muscles that manage urinary function. The electrical pulses can eliminate or reduce enuresis in some children.

About surgery for urinary incontinence at Children’s

The pediatric urology surgery team at Children’s provides next-generation care to neonatal infants, newborns, children, and adolescents from throughout the Upper Midwest. The team consistently performs some of the most cutting-edge surgical procedures available, including newborn surgery, minimally invasive surgery, and robotic surgery, when appropriate. Urologic surgery is performed at Children’s – Minneapolis, Children’s – St. Paul and Children’s – Minnetonka.

• If you are a family member looking for a Children’s specialist in urology surgery, please call the Center for Pediatric Urology at 1-800-992-6983.
• If you are a health professional looking for a consultation or referral information, please call Children’s Physician Access at 1-866-755-2121 (toll-free).