Beyond Bedwetting, Understanding Urinary Incontinence In Children Without Blame

KUALA LUMPUR, Sept 3 (Bernama) -- Persistent urinary leakage in children beyond the age of five can affect their confidence, participation in school, and psychological well-being, although occasional incontinence is part of normal development.

Sunway Medical Centre, Sunway City (SMC) Consultant Paediatric Urologist, Paediatric and Robotic Surgeon Dr Srihari Singaravel said the condition is highly manageable with the right guidance.

“Urinary incontinence in children is a more common condition than parents realise. Most children who are incontinent suffer from daytime urinary incontinence (symptoms of urinary incontinence whilst awake during the day), nocturnal enuresis (bedwetting at night while asleep) or a combination of the two.

“Globally, about 10 to 20 per cent of children experience nighttime bedwetting, while 7 to 10 per cent have daytime symptoms. So, it is not unusual and rarely an issue,” he said in a statement today.

He said bladder control develops gradually, with most children achieving daytime control between the age of two and three, while nighttime dryness may take longer, sometimes up to seven years, adding that bedwetting is not simply due to deep sleep but can occur when the bladder’s signal does not reach the brain in time.

“This means a child may not recognise the need to urinate during sleep. Others may produce more urine at night due to hormonal patterns, or develop habits of holding urine during the day, which can make things worse.

“These are functional issues rather than structural problems. The bladder is healthy but not yet fully coordinated,” he added.

Dr Srihari said parents should take note and seek medical help if the symptoms occur frequently, are accompanied by urgency, or begin to affect the child’s daily life, such as being unable to go more than an hour without having to go to the toilet or more frequent “accidents” at school or at home.

“Other signs include constipation or recurring urinary tract infections, which could also signal a far more serious issue. The bladder and bowel sit very closely together and function as part of the same system. If the bowel is full, it can press against the bladder, reduce its capacity, and make it more overactive,” he said.

Consequently, he said this can lead to urgency, frequent urination, and incomplete emptying, while addressing bowel habits alone significantly improves urinary symptoms in many cases.

Dr Srihari said simple factors such as poor toileting posture can also play a role, as children whose feet do not touch the ground when sitting on the toilet may struggle to empty their bowels properly, which can indirectly affect bladder control.

“The good news is that many children improve with simple, consistent routines and habits rather than immediate medical treatment,” he said, adding that encouraging children to urinate regularly, about every two to three hours, avoiding prolonged “holding”, and ensuring adequate hydration earlier in the day can help.

He also advised reducing excessive fluid intake in the evening and maintaining good bowel habits through a balanced diet with enough fibre and fluids were also important.

“For some children, especially when symptoms persist or begin to affect their confidence, medical support is needed. Treatment depends on the pattern, whether it happens during the day, at night, or both.

He added that medication may be considered for nighttime bedwetting when the condition affects a child’s daily life, such as during school trips or sleepovers, as the medicine mimics the natural antidiuretic hormone, helping reduce urine production at night.

“For daytime symptoms, treatment focuses on the underlying cause. This may include treating constipation or, if needed, medication to relax the overactive bladder. When both are present, daytime symptoms are addressed first,” he said.

However, Dr Srihari emphasises that treatment is not one-size-fits-all, as the bladder’s function should be assessed before starting medication, with tools such as ultrasound, uroflow studies and bladder diaries used to evaluate the condition.

“A common approach to bedwetting involves three months of medication followed by a two-week break in between to assess progress. Many children improve within the first cycle, with most responding well within two to three cycles,” he added.

Dr Srihari said emotional support is also essential, as children with incontinence may feel embarrassed or anxious, especially in social settings, stressing that the child should not be blamed as the condition is not intentional.

He urged parents to focus on their child’s effort, maintain calm routines and avoid punishment, which could increase stress, while teachers and caregivers can also help by allowing easy access to toilets and providing a supportive and private environment.

“Urinary incontinence is a medical and developmental issue, not a discipline problem. Children need understanding, patience, and the right care instead of judgment,” he concludes.

-- BERNAMA