From what age and under what conditions should we focus on urinary incontinence in children?
Urinary incontinence is the most common chronic problem of childhood. It negatively affects children’s daily lives and self-confidence, and this negative impact increases even more with age. Therefore, when urinary incontinence occurs, it is important to treat it with appropriate approaches.
The fullness of the bladder can be felt from the first 1-2 years of age in children and they may start to delay their urination gradually, consciously or unconsciously. However, bedwetting can be seen from time to time until the age of five. Urinary incontinence seen under the age of five is considered as “delayed toilet training”. Parents are guided to provide appropriate attitudes and support for the child to receive appropriate toilet training.
Enuresis or urinary incontinence is common in children. Urinary incontinence is seen in one of every 10 children between the ages of 5-7, while this rate decreases (to 1-2%) in adolescence.
Enuresis is defined as the repetitive, involuntary or voluntary leakage of urine from the bed at night and into the daytime clothes in children older than 5 years of age. Urinary incontinence is sometimes seen at night, sometimes during the day, and sometimes both day and night. Urinary incontinence improves with appropriate approaches and treatment.
What are the causes of urinary incontinence?
The most important cause of urinary incontinence is genetic predisposition. Half of children with urinary incontinence have parents or relatives with urinary incontinence. Again, bladder-related problems, excessive nighttime urine production in these children, having sleep problems and not being able to wake up when their bladders are full are among the important reasons. Less commonly, medical problems such as diabetes, urinary tract infections can cause urinary incontinence.
Stressful life events experienced by children, together with genetic predisposition, may cause urinary incontinence to begin and continue. One of the most common causes is sibling birth. A child who has completed toilet training may start to leak urine due to sibling jealousy with the attention shown to the new baby coming home. This situation, which is usually temporary, persists when the child is neglected and does not really receive enough attention. Again, conflicts of parents, divorce, starting school, hospitalizations, moving to a new environment, physical and sexual abuse, losses can be the cause of urinary incontinence in children.
Do mistakes made in toilet training at the beginning affect urinary incontinence in the future?
Children show different period characteristics with age. The best time for toilet training is around the age of 1.5, when the child’s ability to delay urination begins to develop. This period is also a period when the child starts walking, talking, being very curious and fidgeting around. This period is also a period when the child’s stubbornness and independence characteristics develop. Attitudes about toilet training are important. In this period, the critical, stimulating and controlling approaches of the parents towards the toilet training and other behaviors of the child lead to a work and stubbornness between the child and the child. The child develops an attitude in the form of making and holding the toilet at his own time against the oppressive and stimulating attitudes of the parents in toilet training. Early or late initiation of toilet training is one of the causes of urinary incontinence.
How did the pandemic process we go through affect children in this sense?
From the beginning of the pandemic, children could not go to school, their daily routines changed a lot. They experienced an epidemic disease process that they were trying to comprehend and worried about. This adversely affected their mental state. There was also an increase in the rate of daytime and nighttime urinary incontinence in children during the epidemic period. It is clear that this increase in flower abduction has the effect of anxiety and demoralization, which is more common in children with the epidemic. It should be kept in mind that changes in the child’s daily routines, decrease in physical activity level, consuming more fluids while spending time in front of the screen and changes in sleep patterns may also play a role in urinary incontinence.
How should the family’s attitude be when the problem of urinary incontinence arises?
Urinary incontinence makes life difficult for the whole family. Increases family stress. Parents can be sad, stressed, tense, and angry. Parents should know that there are effective treatments for managing and improving urinary incontinence. They should review how much they warn, control, and stubbornly warn their children. They should see if they make the problem of incontinence the center of fundamental interaction and conflict in all relationships. In the approach of the parents, it is important that the urinary incontinence is not expressed in a way that the child is ashamed of, and that it is not punished. The child may be very upset and embarrassed because of urinary incontinence. Parents should be calm and patient. Starting from the stage when the child is ready, they should support the making of attempts in toilet training without haste.
Is there a cure for urinary incontinence? What kind of treatment do we follow in this process?
Yes, there is a cure for urinary incontinence. First of all, it is important to distinguish whether urinary incontinence is caused by a medical disease. The child should be actively involved in the development of toilet habits. For urine education, homework that the child is ready to do is planned. The homework he can do will increase his motivation. The child is asked to keep a schedule for toilet habits such as going to the toilet and getting up dry. It is rewarded for staying dry. It is recommended to regulate the amount of fluid that the child takes in the evening, to go to the toilet before going to bed, and to take it to the toilet after going to bed. When behavioral approaches and barbers are necessary, alarm devices or pharmacological approaches are used as effective treatment methods in the treatment of urinary incontinence.
If left untreated, will urinary incontinence cause other problems in the future?
Although there are cases that resolve spontaneously, some of the urinary incontinence continues without improvement. Urinary incontinence becomes a problem that impairs the quality of life of the child, youth and family. Children with urinary incontinence may be warned, blamed, punished or exposed to physical violence from time to time by their parents. They often experience difficulties in the form of anxiety of being noticed by others, social exclusion, humiliation, and embarrassment. These children may experience a decrease in self-confidence, problems in friendships, problems in social adaptation, and behavioral problems. As the urinary incontinence problem continues, more anxiety disorders, social phobia, depression, and behavioral problems may be added to the table with age. For this reason, getting treatment support for urinary incontinence in the early period becomes important in terms of preventing mental problems that may arise now and in the future.
