Children and “accidents”: What’s causing urinary problems?

We’ve been discussing children and accidents to great lengths over the last few months. Children who experience bladder problems after the age of 5 may also experience social anxiety, loss of self-esteem, and the confidence to participate in activities with their peers. We’ve talked a lot about helping your child cope at school and discussed dietary changes at some length. You’re likely looking for a concrete explanation as to why accidents won’t go away, and rightfully so!

There are several possibilities, some more likely than others, to explain why your child is having bladder issues & urinary problems. If your child is still having problems after the age of 5 yrs old (leaking, bedwetting, urgency, infection, difficulty emptying the bladder), here are some names, signs and symptoms of possible diagnoses.

What are some diagnoses around children and accidents?

PT for bedwettingThere are several possibilities, some more likely than others, to explain why your child is having bladder issues.  If your child is still having problems after the age of 5 yrs old (leaking, bedwetting, urgency, infection, difficulty emptying the bladder), here are some names, signs and symptoms of possible diagnoses.   In subsequent blogs, we will address a few of these diagnoses at a time and discuss in more depth the cause and possible treatment options of each.

Nocturnal Enuresis:  Also called nocturnal incontinence or simply, bedwetting. This is urine leaking that occurs while your child is asleep.

Daytime Enuresis:  Urine leaking, or  incontinence, while your child is awake. This diagnosis describes the symptom but not the cause of the leaking.

Overactive Bladder:  This used to be calling bladder instability.  Symptoms commonly include high frequency of “peeing” (more than 8 times per 24 hours), bladder urgency that is difficult to control, and possibly some urine leaking. An example of a common scenario for a child with overactive bladder would be losing urine while running to the bathroom or opening the door to the house.

Urge Incontinence:  This is a type of daytime enuresis and is the most common form of functional incontinence in children. It is accompanied by overactive bladder and may have some or all of the symptoms of Overactive Bladder.

Vaginal Reflux:  This occurs in prepubescent girls with leaking that occurs within 20 minutes of normal voiding. This happens because urine gets trapped in the vagina and leaks out during standing or physical activity.

Giggle Incontinence: You  guessed it! Many of us have been caught off guard by a funny incident in the past  that caused us to “pee our pants” (really not funny when it happens to you!) This usually occurs in girls and is often a large loss of urine primarily with laughing.

Neurogenic Bladder: Loss of normal bladder functions due to damage of the nervous system.

Dysfunctional Voiding: Previously call voiding dysfunction. This is when the pelvic floor muscles and the urinary sphincters contract rather than relax during urination and the bladder does not empty effectively. Left untreated, dysfunctional voiding can lead to urinary tract infections and other serious bladder and kidney issues.

Vesicoureteral Reflux: This is an abnormal flow of urine backwards from the bladder towards the kidney. This could be due to a congenital defect (from birth), an obstruction of the bladder, or a urinary tract infection.

Voiding Postponement: Frequent postponement of  the use of the bathroom beyond a healthy range of time (greater than 4 hours for urination or holding bowel movements for more than 1 hour). This can be due to a child’s desire to only use a certain bathroom or resistance to use a bathroom at school for example. From time to time, voiding postponement is part of a bigger psychological disorder.

Constipation:  Defined by  fewer than 3 BM’s per week, straining more than 25% and stools are hard or lumpy (corn on the cob or bunch of grapes).  Because the rectum and bladder are close neighbors, constipation can put pressure on the bladder and contribute to urinary problems.    In one study, 89% of daytime wetting resolved with the resolution of constipation.

In subsequent blogs, we will address a few of these diagnoses at a time and discuss in more depth the cause and possible treatment options of each. At Pelvic Wellness Center, we’re dedicated to helping you and your child manage “accidents”! Call us at (541) 515-6215 in Eugene and at (503) 983-8811 in Salem to discuss how we can help your child.

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