incontinence in children

Overview

Incontinence in children means that a child passes urine at the wrong time or in the wrong place. This can happen during the day, at night, or both. It is not something a child does on purpose. Most children learn to control their bladder gradually, and occasional accidents are a normal part of growing up.

Yes, it is very common. About 1 in 5 children in the UK wet the bed at age 5, and about 1 in 10 still wet the bed at age 7. Daytime wetting is less common but still affects many children.

It affects both boys and girls. Bedwetting is more common in boys, while daytime wetting is slightly more common in girls. It can affect children at any age, but it is most often seen as children are learning to use the toilet.

Symptoms

Common symptoms

• Frequent trips to the toilet
• A strong, sudden urge to urinate that is hard to hold
• Pain or burning during urination
• Wetting pants during the day or bed at night
• Squatting, wriggling, or holding onto themselves to stop urine from leaking

Symptoms in children

• Not staying dry through the night by age 5 or 6
• Daytime accidents after age 4
• Very small or very large amounts of urine each time
• Holding in urine and then leaking
• Crying or straining to pass urine

Symptoms in older adults

• While this article focuses on children, older adults can also have incontinence. Symptoms may include leaking on the way to the toilet, a frequent need to go, or feeling that your bladder is never empty. Older adults should also speak to a doctor, as the cause is often treatable.

Causes

Main causes

• Constipation: Hard, compacted stool presses on the bladder and can cause wetting.
• Urinary tract infections (UTIs) can irritate the bladder and cause urgency or pain.
• Overactive bladder: The bladder squeezes too soon or too often.
• Deep sleep: Some children don't wake up when their bladder is full.
• Stress or big changes at home or school can trigger wetting.
• Delayed bladder control from developmental or physical reasons.
• In rare cases, anatomical problems with the kidneys or urinary tract.

Risk factors

• A family history of bedwetting
• Chronic constipation
• Being born prematurely
• Obesity
• Conditions like ADHD or autism
• Having a small bladder capacity

When to see a doctor

See a doctor urgently if:

• If your child has severe pain in the belly, back, or side, especially with a fever
• If there is blood in the urine or painful urination
• If your child suddenly starts wetting after being dry for 6 months or more with no clear reason

Book a routine appointment if:

• If daytime wetting continues beyond age 4 or 5
• If bedwetting continues beyond age 6 or 7
• If you are worried about your child's drinking or toileting habits
• If your child has never had a dry period of 6 months by age 5
• If wetting is causing your child distress or embarrassment

Diagnosis

A doctor will start by asking about your child's symptoms, fluid intake, toilet habits, and any family history. They will usually ask for a urine sample to check for infection or other problems.

Tests that may be done

• Urine test (urinalysis)
• Bladder diary: tracking when your child drinks, voids, and has accidents
• Ultrasound scan of the kidneys and bladder
• Sometimes a test called urodynamics, which measures how the bladder stores and empties urine

What to expect at your appointment

The doctor will examine your child and talk through the diary you keep at home. Most children do not need specialist tests. The main aim is to identify any treatable cause, such as constipation or a urine infection.

Treatment

Treatment depends on the cause. Many children improve with simple changes to toilet habits, drinking habits, and diet. The earlier you seek help, the easier it is to manage.

Self-care at home

• Encourage your child to use the toilet every 2 to 3 hours during the day.
• Make sure your child drinks plenty of water during the day, but limit drinks in the hour before bed.
• Avoid sugary or fizzy drinks and drinks with caffeine, like cola or tea.
• Treat constipation with more fiber and fluids.
• Use a bedwetting alarm at night to help a child wake up when their bladder is full.
• Praise your child for trying, never punish or shame them.

Medical treatments

If self-care is not enough, a doctor may suggest medicines that relax the bladder or reduce the amount of urine the kidneys make at night, but only after a proper assessment and explanation of risks and benefits. Antibiotics may be used if there is a urine infection. These are always prescribed by a healthcare professional.

When is surgery considered?

Surgery is rarely needed for incontinence in children. It may be considered for anatomical problems that are found with scans, or if other treatments have not worked, but this is unusual.

Living with this condition

Use waterproof mattress covers and keep spare pyjamas nearby. Make the toilet an easy and comfortable place for your child to use. Work together with your child, and remember that a calm routine helps more than nagging.

Lifestyle tips

• Set a regular toilet schedule, including a last trip to the toilet before bed.
• Make sure your child has easy access to a toilet at school and while out.
• Encourage physical activity to help regular bowel movements.
• Keep a positive attitude and focus on small steps of progress.

Diet and exercise

A balanced diet with plenty of fiber (fruit, vegetables, and wholegrains) helps prevent constipation, which is a common cause of wetting. Regular exercise and physical play also support healthy bowels and bladder habits.

Mental health and emotional wellbeing

Incontinence can make children feel embarrassed, anxious, or different from their peers. It can affect confidence and friendships. It is important to reassure your child that it's not their fault and that many children go through it. If you notice low mood or withdrawal, consider talking to your GP or school nurse.

Prevention

Not all incontinence can be prevented, but many cases can be helped by encouraging healthy toileting habits from an early age, avoiding constipation, and responding to your child's cues. It's also important to not begin toilet training before your child is developmentally ready.

Vaccines

Not applicable.

Screening programmes

There is no routine national screening for childhood incontinence, but healthcare visitors and school nurses can help identify problems early through regular reviews.

Complications

If left untreated

• More frequent urinary tract infections
• Skin irritation or soreness from constant wetness
• Low self-esteem and social withdrawal
• Difficulty concentrating at school
• Family stress and conflict

Long-term outlook

The outlook is very good. Most children eventually become dry, especially with the right support and treatment. Even if it takes time, the large majority of children will outgrow or successfully manage incontinence. With patience and the right help, your child can enjoy a full and happy life.

Find support

International organisations

• International Children's Continence Society (ICCS) ↗

Local organisations

• ERIC (Education and Resources for Improving Childhood Continence) ↗ · United Kingdom

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