Incontinence in children can be caused by a variety of factors. Physiological causes of children's incontinence include slower development of the bladder and/or the body's signals that tell the child that he or she needs to empty the bladder. A hormone deficiency, long periods of sleep, and caffeine consumption are also linked to incontinence in children. The primary psychological cause of children's incontinence is anxiety, often resulting from a stressful situation in the home. Incontinence in children can be upsetting to both the affected child and his or her parents, but experts seem to agree that children's incontinence is not generally a concern; for many children, incontinence is just a natural part of growing up.
While infants' bladders empty automatically as the need arises, children eventually develop the ability to relay messages between their brain and other body systems, including their bladder. They begin to be able to tell when their bladder is full, and they can control when and where they void. Incontinence in children occurs when the child is unable to control voiding his or her bladder.
Incontinence in children has two main categories: daytime, and the far more common nighttime. Daytime incontinence is more common among girls, though boys also have been known to experience this problem. A common physiological cause of daytime incontinence in children is a too-active bladder. Incontinence occurs when the muscles around the urethra are unable to hold in the urine when the bladder suddenly and/or forcefully contracts. This type of incontinence can be the result of a urinary tract infection (UTI).
Having a small bladder, having constipation, consuming caffeine and, more rarely, structural problems with the bladder or urethra may also cause daytime incontinence in children, though daytime incontinence is more often attributed to psychological reasons. A child simply might not want to interrupt his or her activities to use the bathroom, may prefer not to use the school restroom, or may be experiencing some other form or anxiety or stress. Any of these circumstances can cause a child to hold his or her urine past the point of needing to void, resulting in incontinence. Repeated suppression of the need to empty the bladder may result in a UTI.
Nighttime incontinence is believed to be more frequent in boys, though both boys and girls are affected. A strong family history of bedwetting may indicate a genetic link to nighttime incontinence, because the chances of a child being a bedwetter if his or her parents were both bedwetters is as high as 80 percent. Common physiological causes of nighttime incontinence in children include a bladder incapable of holding more than a small amount of urine, delayed development of the body's bladder-fullness signals, and low levels of the antidiuretic hormone (ADH) that reduces the body's need to urinate overnight.
Less commonly, nighttime incontinence in children may be caused by obstructive sleep apnea, a condition in which a child stops breathing during sleep because of blockage by the adenoids or tonsils. Even rarer is the incidence of structural issues such as the bladder or urethra being blocked. Psychologically, if a child is experiencing anxiety stemming from anger or tension in the home, an unfamiliar environment or a significant event in the child's life — such as the birth of a sibling — it may trigger nighttime incontinence.
Some physiological reasons for incontinence in children will resolve themselves in time, while medications are available to treat others. Bladder training, which strengthens the muscles of the bladder and urethra, may also help. Following a schedule for urination and avoiding caffeine and other foods or drinks that may trigger incontinence also are strategies that may help to treat incontinence in children. Parents and caregivers are encouraged to handle a child's incontinence with patience and understanding to maximize the chance for successful treatment and minimize stress that could make it worse.