Urinary incontinence and bladder emptying disorders

Children are said to have incontinence if they experience uncontrolled urine loss during the day. However, achieving complete bladder control is a very individualised process and is usually achieved between the ages of 2 and 5. This requires a complex interplay of peripheral and spinal nerves with central areas of the brain. In infancy, bladder emptying is still uncoordinated and is controlled reflexively via bladder filling. In infancy, there is a transitional stage with increasing bladder maturation and thus the possibility of perceiving relevant bladder filling. Later on, the child learns to coordinate the active muscles and the bladder muscle with each other. Nocturnal bladder control is often achieved later (months to years). Incontinence is a very common problem. In 7-year-old children, up to 10% still suffer from incontinence, in 12-year-old children it is still around 1-2%.

The uncontrolled loss of urine (enuresis) is the main symptom, which can occur during the day or at night or in combination. It is often accompanied by an imperative urge to urinate, holding manoeuvres, avoidance tactics, dribbling of urine or pain when urinating. Defecation problems (hard bowel movements, pain during bowel movements, faecal retention) are also very common and have a negative effect on coordinated urination.

During the consultation, the first step is a detailed discussion with a medical history and a physical examination. In addition, a drinking and urine log as well as a faeces log should be carried out at home, as this can provide a lot of information about the cause of the incontinence. In addition, an ultrasound of the kidneys and urinary tract, a urinalysis and a measurement of urine flow (uroflow with/without EMG) are carried out to rule out anatomical causes.

Only in rare cases are further investigations such as MCUG (micturition cystourography), bladder pressure measurement (bladder manometry) or cystoscopy (cystoscopy) necessary.

The treatment of functional incontinence includes important basic measures such as drinking and micturition training and the consistent treatment of constipation (faecal retention). If necessary, additional urophysiotherapy with pelvic floor training and/or medication support is offered. For the treatment of nocturnal enuresis, there is also the option of treatment with a wake-up device.

Psychological support can sometimes also be helpful in cases of high levels of suffering or psychological stress in the family.

We attach great importance to offering holistic care for children and their families at the UKBB. An interdisciplinary team consisting of urologists, nephrologists, specialised nursing staff, physiotherapists and psychologists is available for this purpose.

Incontinence almost always has a good prognosis with complete freedom from symptoms and spontaneous improvement over time.

• Enuresis nocturna in childhood and adolescence; V. Sommer - S. Holland-Cunz - M. Frech University Children's Hospital Basel UKBB, Urol. Practice 2021
• Always wet, what next? Incontinence in childhood - the bladder takes centre stage. Shavit¹,; R. Draths², ¹Paediatric Surgery Children's Hospital Lucerne, ²Gynaecology and Obstetrics, New Women's Clinic Lucerne; Paediatrics 4/2012