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Urinary incontinence in children: suggestions for definitions and terminology
1Department of Paediatric Surgery, East Hospital, Gothenburg, Sweden.
Insights
Childhood urinary incontinence involves urine leakage in children aged 5+, categorized by detrusor, sphincter, or combined types. Understanding these classifications is key to diagnosing and managing pediatric incontinence effectively.
Area of Science:
- Pediatric Urology
- Child Health
- Urology
Background:
- Childhood urinary incontinence is defined as involuntary urine leakage in children aged 5 years or older.
- It is classified into detrusor, sphincter, and combined types, with subtypes like daytime urge incontinence and night-time enuresis.
- Incontinence is further subdivided into night-time (most common) and daytime forms, with day wetting having organic or functional causes.
Purpose of the Study:
- To define and categorize childhood urinary incontinence.
- To differentiate between organic and functional causes of day wetting.
- To explain the pathophysiology of unstable bladder and its potential progression to Hinman's syndrome.
Main Methods:
- Literature review and synthesis of existing definitions and classifications.
- Analysis of etiological subdivisions for day wetting.
- Description of the progression from unstable bladder to non-neurogenic neurogenic bladder (Hinman's syndrome).
Main Results:
- Childhood urinary incontinence is characterized by specific leakage criteria and categorized into detrusor, sphincter, and combined types.
- Day wetting is etiologically divided into organic (structural or neurogenic) and functional causes.
- Functional day wetting often results from an unstable bladder, potentially leading to dyscoordination and 'lazy bladder,' ultimately Hinman's syndrome.
Conclusions:
- Accurate classification of childhood urinary incontinence is essential for appropriate diagnosis and management.
- Understanding the distinction between organic and functional causes, particularly unstable bladder, is crucial.
- The progression to conditions like Hinman's syndrome highlights the importance of early recognition and intervention.
Abstract:
The definition of childhood urinary incontinence, used here, is leakage of at least 1 ml of urine, at least once a week, in a child from 5 years of age. The types of incontinence are defined as detrusor incontinence (daytime urge incontinence and night-time enuresis), sphincter incontinence (presenting clinically as stress incontinence in the less serious form, as continuous dribbling of urine in the more serious one), and combined incontinence (the combination of detrusor hyperactivity and sphincter incompetence found in many children with neurogenic bladder dysfunction). Urinary incontinence in children is subdivided into night-time (most common) and daytime incontinence. Day wetting is aetiologically subdivided into incontinence due to organic or functional causes. The organic causes can be either structural (e.g. epispadias) or neurogenic. Functional day wetting is incontinence not caused by disease, injury or congenital malformation, and is almost always urge incontinence due to an unstable bladder. Unstable bladder in children may activate the sphincteric guarding reflex, leading to dyscoordination between the sphincter and the detrusor, and, eventually, overdistension of the bladder with a reduced contraction power of the detrusor ('lazy bladder'). Ultimately, Hinman's syndrome (non-neurogenic neurogenic bladder) may develop. The term enuresis should be used to denote incontinent, complete micturitions and should thus be reserved for bedwetting and giggle enuresis.