Treatment of daytime urinary incontinence in children: a systematic review of randomized controlled trials

Premala Sureshkumar, Wendy Bower, Jonathan C. Craig, John F. Knight

Research output: Contribution to journalReview article

45 Citations (Scopus)

Abstract

No intervention tested in a trial to date has been proved to be of benefit to children with daytime urinary incontinence.

Almost 20% of children 4 to 6 years old wet their pants, albeit infrequently, with 3% wetting twice or more weekly. 1 Children have been shown to rate wetting pants at school as the third most catastrophic event that could occur, behind death of a parent or going blind. 2

Treatment of children with daytime urinary incontinence is difficult and relates to a thorough diagnosis. Incontinence in a child with the urge syndrome requires different intervention compared to incontinence in a child with urgency associated with voiding dysfunction. In some children a thorough explanation of the underlying causes and the expected progress of resolution is sufficient treatment. 3 Generally, initial intervention involves standard therapy or bladder drill, a timed schedule of drinking and voiding to achieve initial dryness. The approach emphasizes routine voiding efforts in conjunction with optimal biomechanical positioning. More active treatment may include pharmacotherapy, pelvic floor muscle relaxation techniques and biofeedback, either as stand-alone therapies or in combination. 4–8 Pharmacotherapy generally involves anticholinergics such as oxybutynin, which may cause headache, blurred vision, constipation, altered behavior, dry mouth and flushed cheeks. 9–11 Biofeedback as an intervention uses the signal derived from electromyographic measures of various skeletal muscle groups and/or recordings of urine flow to represent voiding dysfunction to the child and allow him or her to learn relaxed unopposed voiding techniques. At least half of the families with children who have daytime urinary incontinence do not seek medical help. 12 The reasons for this are unknown but may include a general belief that “not much can be done anyway” or “they will grow out of it.”

This study was undertaken to summarize the existing research information about the benefits and harms of interventions used for children with daytime urinary incontinence. It is hoped that this study can inform clinicians and families about those interventions that are effective and those that should be avoided, and highlight research questions that require further study.
Original languageEnglish
Pages (from-to)196-200
Number of pages5
JournalJournal of Urology
Volume170
Issue number1
DOIs
Publication statusPublished - 1 Jul 2003
Externally publishedYes

Keywords

  • children
  • urinary incontinence
  • drug therapy

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