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Daytime urinary incontinence in children and adolescents
Anka J Nieuwhof-Leppink1, Rogier P J Schroeder2, Elise M van de Putte3
1Department of Medical Psychology and Social Work, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands; Department of Urology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands.
Insights
Daytime urinary incontinence affects 7-10% of children. Urotherapy, a bladder rehabilitation program, is the primary treatment, addressing function and comorbidities to improve quality of life.
Area of Science:
- Pediatric Urology
- Pediatric Nephrology
Background:
- Daytime urinary incontinence is prevalent in 7-10% of children aged 5-13 years.
- Incontinence presents with various subtypes related to bladder storage and voiding phases.
- Risk factors are diverse, including genetic, environmental, and behavioral elements.
Purpose of the Study:
- To outline the multidisciplinary approach to diagnosing and treating pediatric daytime urinary incontinence.
- To emphasize urotherapy as the first-line treatment for all subtypes.
- To highlight the importance of managing comorbidities alongside bladder rehabilitation.
Main Methods:
- Urotherapy: bladder re-education and rehabilitation to optimize bladder-sphincter unit function.
- Comprehensive assessment to identify and address contributing factors like constipation and infections.
- Pharmacological interventions for severe overactivity or refractory comorbidities.
Main Results:
- Urotherapy is effective and the cornerstone of treatment for pediatric daytime incontinence.
- Integrated management of comorbidities significantly enhances treatment outcomes.
- Successful treatment requires patience but substantially improves children's quality of life.
Conclusions:
- Daytime urinary incontinence in children necessitates a tailored, multidisciplinary approach.
- Urotherapy, combined with management of associated conditions, is crucial for successful outcomes.
- Addressing incontinence is vital for enhancing the well-being and quality of life in affected children.
Abstract:
Daytime urinary incontinence is common in the paediatric population and affects approximately 7-10% of children (aged 5-13 years). Several subtypes of daytime incontinence, which are classified according to their relation to the storage and voiding phases of bladder function, exist. Risk factors for these subtypes of incontinence can be genetic, demographic, environmental, behavioural, or physical. Therefore, treatment is multidisciplinary and needs an adequate diagnosis to be successful. Urotherapy is the first-line treatment for all types of daytime incontinence. It can be defined as bladder re-education or rehabilitation, aiming at correcting the filling and voiding function of the bladder-sphincter unit. Comorbid problems, such as constipation, urinary tract infections, and behavioural problems should also be treated during urotherapy. For comorbidities and severe bladder overactivity, medication might be necessary. Although usually effective, treatment of daytime urinary incontinence in children is often complex and requires patience. Nonetheless, patients and parents are usually motivated for urotherapy, since quality of life is severely reduced in in children with incontinence.
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