She Magazine JULY 2016 | Page 58

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. 60 JULY 2016 SHEMAGAZINE.COM