Management of Incontinence in Children

Introduction to Incontinence Management

The American Academy of Pediatrics recommends determining if incontinence in a 5-year-old child represents normal developmental variation or pathological enuresis, then implementing a structured program of urotherapy combined with treatment of any underlying conditions like constipation 1, 2

A thorough assessment should include evaluating voiding patterns, such as frequency, urgency, holding maneuvers, interrupted stream, and weak stream, to determine the type of incontinence 1
Bowel habits should be assessed, as constipation is strongly associated with incontinence 1, 2
Family history should be considered, as enuresis has strong genetic links 3
A frequency-volume chart should be used to document fluid intake, voided volumes, and incontinence episodes 1

The American Urological Association recommends a regular voiding schedule, instructing the child to void at regular intervals, to help manage incontinence 1
Proper voiding posture, including a stable sitting position with buttock and foot support, and comfortable hip abduction, should be ensured 2
Hydration management, including liberal fluid intake during morning/early afternoon and minimizing evening fluids, can help reduce incontinence episodes 1
Constipation treatment, such as using stool softeners like polyethylene glycol, should be implemented if constipation is present 1, 2
Positive reinforcement, including reward systems and calendars to track dry days/nights, can help motivate the child to achieve continence 1, 3

Desmopressin may be considered for children with nocturnal polyuria (excessive nighttime urine production) 1
Biofeedback training may be used for children with dysfunctional voiding patterns 2

Punishment or shaming should be avoided, as these approaches are counterproductive and can worsen incontinence 3
Premature treatment should be avoided, and active treatment should usually not start before age 6 for nocturnal enuresis, but daytime incontinence at age 5 warrants intervention 1
Ignoring constipation can lead to persistent bladder problems, and constipation should be treated aggressively 2
Overlooking family impact can lead to significant family stress and affect the child's self-esteem, and family support and counseling should be considered 3

Approximately 14-16% of children with enuresis will spontaneously resolve each year 3
With structured treatment approaches, success rates of 90-100% can be achieved for daytime incontinence 2
Daytime continence is typically achieved before nighttime continence 3