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Youth Incontinence

Information in this section is courtesy of website)

The causes of children’s bladder weakness

Bedwetting is the most common form of children’s incontinence, with day wetting affecting just 2-4% of 5 to 7 year-olds. The following are the most common causes of children’s bladder weakness.

Developmental Causes

The bladder empties by opening and contracting muscles in response to signals from the brain that it is full. If this nerve/muscle coordination is slow to develop, the bladder can sometimes fill before the child’s brain knows about it. Alternatively, the muscle (valve) could just be too weak.
Children usually sleep more deeply than adults and take longer to fully wake up. This sometimes means they don’t sense the signal telling them to empty their bladder – or else can’t wake up in time.

At night, the body produces a larger amount of anti-diuretic hormone, or ADH. This slows the production of urine, reducing the need to urinate. If, for any reason, it fails to do this, the bladder may overfill.

All of the above conditions usually resolve themselves with time. Anxiety is also often thought to be a cause of bladder weakness in children, but there’s little scientific evidence to support this. However, if your child is anxious, it’s important to find out the cause and handle it sensitively.

Medical Causes

Bladder weakness in children could also be a side effect of a medical condition or disability. In cases of cerebral palsy, spina bifida, brain injury or nerve damage, the ability to receive the correct signals from the brain to empty the bladder may be physically impaired. Occasionally a repeated urinary infection or even a minor deformity in the urinary tract could also be the cause.

The hereditary link

There appears to be a hereditary link to bladder weakness, which can continue through several generations. Broadly speaking, there’s a 40% likelihood of a child wetting the bed if one parent did, rising to 70% where it was both parents.

Day wetting

Daytime wetting, when not caused by a urinary infection or anatomic reasons, could result from an overactive bladder or infrequent voiding.

Overactive Bladder

This concerns the muscles surrounding the urethra that are used to prevent the passing of urine. What happens is that they contract involuntarily, forcing the urine out. It is often a consequence of a urinary infection and is more common in girls.

Infrequent voiding

Some children put off going to the bathroom, either because they don’t like using the school facilities or because they don’t want to miss out on something, and they ignore their urge. This can lead to an overfilling of the bladder and accidental urination. It can also cause infections.

Functional Incontinence in children

This is where your child is physically unable to reach the bathroom. It may be due to problems with movement or it could be because your child uses a wheelchair. In the latter case, it is likely to be both fecal and urinary incontinence. If your child is able to get to the bathroom on their own but this takes time, make sure access to the bathroom free is of obstacles and ensure they have clothing that is simple to remove. However, the most important thing is to use protective underwear that keeps them dry and comfortable. This limits the risk of irritations and skin infections that are often suffered by people who are seated or lying down for long periods.

Practical Tips for Parents with Children with Bladder Weakness

General tips for teachers and parents
Here are some useful tips on how to manage your child’s bladder weakness we’ve collected from parents, nurses and teachers.
Tip 1 – Be patient. We know it’s hard, but be patient. Most children grow out of bedwetting, and if the child is 5 or under there’s really no need for concern.
Tip 2 – Be calm and supportive. Remember that children are very alert to impatience, annoyance or anxiety.
Tip 3 – Tell them how common bladder weakness is. Your child may feel isolated and worried that there is something seriously wrong with them. Mention that other children at school may well have it but wouldn’t necessarily talk about it. All that’s happening is that their bladder isn’t working correctly yet.
Tip 4 – Explanations make things seem safe, so give your child a biology lesson (you could use the information below). With younger children, perhaps you could tell it like a story: “‘Mr. Bladder’ is still learning his job and getting to know everyone else… soon they’ll all be getting along well together and everything should work fine.” Knowing how everything works and being told that eventually it will be better can take the mystery and fear out of the situation. If you need more information go to Causes.
Tip 5 – Remember that your child should still drink liquids when they need them. It may seem odd, but cutting down on liquid intake tends to concentrate the urine, which can increase irritations and problems. So allow them to drink as normal, though, if possible, not just before going to bed.
Tip 6 – For parents, let teachers know if your child has daytime problems so they can provide support for the child and ensure easy access to the school lavatory. Another good idea is to pack a spare pair of underwear in their gym or school bag.
Tip 7 – Let your child know if you or a sibling had similar problems. It gives them hope to realize that others have been through what they’re going through and that it was just a temporary phase.
Tip 8 – Nip all peer teasing in the bud. Kids can be unkind to each other, especially when it comes to bedwetting. So it’s important to explain (not by telling off) that everyone has physical differences: some are short-sighted, some have allergies, some have birthmarks, etc.  You should remind them that: “Different people develop at different rates and it’s not something they can control. However, being nice to people and helping them when they are vulnerable is within everyone’s control.”
Tip 9 – Don’t let the child’s bedwetting become their defining feature. Your child may be an actor, an artist, a sportsman, an explorer, a nurturer or a mischievous imp, but he or she should never be ‘a bedwetter.’
Here are some useful tips on how to manage your child’s bladder weakness we’ve collected from parents, nurses and teachers.
Tip 1 – Make some practical changes. You could place bed linen on a shelf in the child’s room so it’s handy in the middle of the night when you’re sleepy. Also, keep an extra duvet ready (since it’s not only the sheets that get wet).
Tip 2 – Invest in products to protect the mattress, such as an undersheet or underpad. And ensure any dirty linen is quickly removed for laundry.
Tip 3 – If your child is having friends over, just check the bed is clean so your child won’t be embarrassed in front of their friends. And, if your child is worried about an accident in front of friends, wearing protective underwear with odor control will help them to relax and enjoy their playdate to the fullest.
Tip 4 – Managing sleep overs.
Invest in a washable sleeping bag. You could then put a TENA product in there (or in the pajamas within it) so they can change when inside the bag. They can then leave the product there afterwards when they wake up.
Tip 5 – Managing odor
Odor can raise suspicions, so it’s good to use purpose-made pads or pull-ups that can neutralize unwanted odor.
Tip6 – When you go to bed, wake your child up so they can go to the bathroom. If they are unable to last the whole night, this will establish a routine so they can empty the bladder part-way through their night’s sleep and save your sleep.
Tip7 – If you’re going to see the doctor with your child, call ahead to discuss the situation. That way you won’t have to discuss a detailed history in front of your child and embarrass them unnecessarily. All three of you can then have an open and straightforward discussion without talking over the child’s head.

Other Resources


National Kidney and Urologic Diseases Information Clearinghouse

American Academy of Pediatrics

American Urological Association Foundation

National Association for Continence

National Kidney Foundation

The Simon Foundation for Continence

Society of Urologic Nurses and Associates