When Your Child
is Incontinent
Christopher Fukuda, MD | McLeod Urology Associates
F
ew things are more distressing to a family
than a child who is continuously wet beyond
the expected age of normal toilet training.
The child suffers the derision of his or her classmates.
Odors can be offensive. Laundry mounts, and the
young victim agonizes, feeling helpless.
The child may be doubled over with pain from
lower abdominal cramps arising from the bladder.
If they cannot reach the bathroom, they can wet
themselves despite their best efforts to hold the
urine. Misunderstandings about a child with a
voiding dysfunction and urinary incontinence can
lead to increased family tension. The family can,
however, take comfort from the realization that
1) the problem is common and 2) children generally
outgrow it.
Of all children with a wetting problem, 10 percent
will have only symptoms by day, 75 percent only by
night and 15 percent have both day and nighttime
incontinence. Most children grow out of nighttime bed
wetting, but those suffering a daytime problem may
need help.
Inefficient voiding (not emptying the bladder when
it’s full) puts pressure on it while leaving urine in the
bladder. Besides a wetting problem, if untreated,
the situation can lead to infection or, most seriously,
kidney damage or failure.
Although there are some children who are wet from
anatomical causes -- such as spina bifida or tumors
-- the majority of youthful incontinence problems
are due to abnormal urination patterns, in which the
various parts of the urinary tract don’t work together.
Fortunately, the majority of these children can be
trained into a normal bathroom pattern.
Bladder retraining focuses on allowing the strained
muscle to recover. Two important principles are
incorporated: 1) frequent urination and 2) complete
emptying of the bladder. It’s also important to reduce
any causative psychosocial stressors in the child’s
environment such as parental strife, emotional
abuse or other family crises. The use of certain
bladder relaxing medications can also help
accomplish these goals.
A program of timed voiding should be initiated. The
time of emptying the bladder should be determined in
advance and should be rigidly followed. In general, a
voiding schedule of every two hours during the day is
selected and marked on a calendar or diary. The child
should be sent to the bathroom at the appointed time,
regardless of whether they feel a “need” to urinate.
program is not rigorously followed. Once a normal
pattern of voiding is reestablished and maintained for
a while it is usually durable.
The expenditure of time and energy to normalize
bathroom habits can be considerable and exhausting
to both the parents and the child. There can be a
decided tendency to slough off or circumvent these
training sessions in favor of simpler or less timeconsuming approaches. The parents will often tell
the child to do this himself or else rely on medications
alone to correct the problem; however, the result of
such shortcuts often is failure.
There is no substitute for the discipline required
to adhere to timed voiding, concentrating on a
continuous stream at every void, and maintaining
careful records in a voiding diary. Progress can be
agonizingly slow at times but only with proper
dedication to the effort can ultimate success be
achieved. However, once you’ve achieved the goal
- a dry child with a normal bathroom cycle – you’ll find
the effort well worth it.
The more severe the problem the longer the
treatment and greater the vigilance must be for
possible relapses. Generally, the family should expect
to commit to six to 12 months of retraining. Relapses
are common during the early treatment phase if the
A native of Vermont, Dr. Christopher Fukuda is an eighth generation physician with a family lineage of healing and medicine
from his ancestors in Japan. For 20 years, Dr. Fukuda was the primary urologic consultant for the Vermont State Clinic for
Children with Special Health Care Needs, instilling a commitment and passion for children and their care. Dr. Fukuda welcomes
new patients of all ages by physician referral. For more information, call McLeod Urology Associates at (843) 777-7555.
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JULY 2016
SHEMAGAZINE.COM