“Bedwetting once a week is clinically significant, the size of the accident doesn’t matter,” Dr Aniruddh Deshpande, Paediatric Urologist and Head of Surgery at The Children’s Hospital at Westmead tells Bridge.
“Small regular daytime accidents can impact children's mental health, especially older girls and non-caucasian children.”
In 2011, Dr Deshpande and his colleague published a study on the impact of incontinence on children's lives. Though the study was published over a decade ago, not much has changed. “Most children of preschool age will have the odd accident. It has to be at least once a week to be considered clinically significant over the age of five in the daytime and the age of seven for nighttime wetting. But the size of the accident is not that important, because even small accidents can affect children mentally,” says Dr Deshpande.
“All children and families should seek help and support for urinary incontinence—no matter if it appears to be small amounts or relatively infrequently.”
Signs to look out for in older children and teens
Your school-age child or teen may not feel comfortable telling you that they are experiencing urinary incontinence, so here are some signs they may have a problem:
- An unusual amount of underwear in the laundry basket
- Smelly underwear, although it is not unusual for underwear to be smelly after school
- Skid marks in underwear
- Avoiding social activities, school camps or sleepovers away from home
- Avoiding sports due to leakage during strenuous activities
Urinary leakage is not often physically harmful in itself (if there is no underlying medical condition), the harm comes from the impact it has on the child’s self-esteem and mental wellbeing. You have to be kind, compassionate and understanding when you talk to them about their leakage. Reassure them there is help available and with treatment and time it can be resolved.
Common Causes of urinary leakage (incontinence) in otherwise healthy school-age children
“One cause of urinary issues can be bladder/ bowel dysfunction. This is when you get bowel (poo) leakage and constipation at the same time, and the combination of symptoms impacts the bladder for example recurring urine infections and wetting
or leakage.”
“Another cause of wetting in children can be if the pelvic floor becomes out of sync with the bladder in young girls—treatment for this is retraining the muscles.”
“I see a lot of neurodiverse children with ADHD,” Dr Deshpande tells Bridge. “ADHD and leakage are very strongly linked due to the neural networks in the neurodivergent brain. Our understanding of these processes is on the rise.”
“I also see cases where a child has had too much screen time and other distractions, so they learn to ignore their normal bladder and bowel sensations. This takes a lot of work to relearn, but it is possible. I encourage parents to get help as soon as possible, as the older the child is, the more it will impact their self-confidence and self-esteem.”
Treatment available
“The four most important things to prevent continence issues are a consistent toilet routine, eating fibre such as whole grains, fruits and veggies, drinking enough fluid (4-6 cups a day), and regular exercise. If you reflect on your child’s day you might be able to make some lifestyle changes to help their condition."
“Often your school-aged child or pre-teen will not confide in you about their toilet issues. But once you notice some of the signs there are tools medical professionals can use to decipher if the incontinence is due to a physical issue or a mental issue.”
While your GP will probably be your first port of call, they will get help from additional experts. Most significant or refractory (not responding to treatment)continence problems are best dealt with by multiple health professionals to make sure the mental, physical and lifestyle aspects are all covered. People involved in your child’s team may include a paediatrician, paediatric urologist, continence nurse, psychologist, dietitian, physiotherapist and/or an occupational therapist.
What can families expect from treatment?
“The first thing I tell the parents of my patients is to manage their expectations. It takes a long time to make change with continence problems, especially if it involves the child relearning brain/bladder connection. Parents are the daily caregivers and have to make changes diligently. Unfortunately, there is no shortcut when it comes to bladder problems in children.”
“Parents also have to remember that the reason they are seeking treatment for their child’s wetting is to improve their quality of life, so one of the most important aspects is supporting the child or teen with body image and self-esteem. Anxiety around social, sports or school events can be common.”
Short-term things you can do to help them get involved with regular activities while they work on their bladder control could be purchasing reusable continence underwear which are absorbent, neutralise smells, and most importantly are very discreet. There are several brands which make underwear for children from 2-16 years old in bright colours with nice patterns which, at a glance, look like normal underwear. A small change like this could significantly increase your child’s confidence while you work on longer-term changes.
As all parents will know, getting children of any age to cooperate and stick to a plan isn’t always easy. While Dr Deshpande doesn’t recommend bribery with lollies or chocolates to stick to their medical regime, he says there can be a place for a ‘token economy’ in certain situations to help children be consistent and work with you on their treatment.
Get Help
If you or your child are affected by any of the topics covered in this article, contact the FREE National Continence Helpline 1800 33 00 66 (8am-8pm AEST Mon-Fri) for advice from a qualified nurse continence specialist or book in with your GP for guidance and referral to a specialist.