Definition and causes
Incontinence is all forms of involuntary urination in children except involuntary nocturnal urination . Incontinence is very frequent. The incidence is about. 6% for girls and 4% from the boys at school. The special type of urge incontinence, where inkontinensen is forudgået of a very strong / tenderers vandladningstrang, is even more frequent and seen in 20% of 7 year old girls.
We can divide the causes of incontinence in three groups:Neurological disorders, diseases of the urinary tract structural and functional reasons.
Neurological disorderswith the disruption of the function of the brain or spinal cord can cause problems with blærefunktionen and result in incontinence. The main diseases are:
- Cerebral palsy .
- Degenerative diseases in the central nervous system. In children, it is especially on the rare inherited metabolic with deposits of various biological substances in the brain and nervous system.
Structural diseasesin the urinary tract is often caused malformations. Misdannelser in urinvejenes building can interfere blærefunktionen and therefore cause incontinence. The main diseases include:
- Epispadiis a birth defect in which the lower bugvæg and forvæggen in the bladder does not close as normal during foetal development. As a result, there is a direct connection to blærens home from the environment. It is very rare and is seen by some. 2 births a year in Denmark.
- Ektopisk ureteris a birth defect in which the urethra result not in the normal place.
- Urogenital sinusis a birth defect kumuha girls, where the opening of the vagina and urethra resulting in a single cavity (sinus) instead of separately.
Functional reasonsis the most frequent. Here there is no illness, and inkontinensen due to an error in urinvejenes function. The most common cause is a overaktiv bladder, also known asurge syndrome, Where the musculature of the bladder that provides for blæretømning, is overaktiv. Another, but less frequently, functional reason is poor coordination between blæremuskulaturen and blærens lukkemuskel during urination.
In girls can be seen two special forms of incontinence.Vaginalrefluksseen often in overweight girls, which drive lårene together during urination. This block urinstrømmen that instead runs to the vagina. Urinen can later discharged from here and can resemble involuntary urination.Fniseinkontinensseen most often in girls, are not yet in puberty. Inkontinensen consists of a sudden emptying of the bladder in laughter. The reason for this is unknown.
Neurological and structural causes of incontinence are rare. Most caused functional problems, of which the most common is overaktiv bladder.
Incontinence is often while constipation and enkoprese . Treatment of constipation can often solve the problem of incontinence.
Symptoms of incontinence
The most common symptoms are:
- Sudden and sharp vandladningstrang (urge). This can be for girls be accompanied bysquatting, Where the girl by the urge set in the chop and push against the heel area of the urethra to reduce blærens contraction and improve lukkemuskulaturens function.
- Frequent vandladninger (Pollakisuri). Often more than 10 vandladninger in the daytime.
- Smertefuld urination (dysuria). Ses frequently by urinary tract infection.
- Involuntary urine (incontinence).
- Repeated urinary tract infections .
Precautions and diagnosis
If your child has not acquired control of his urination in 4 to 5 years of age, you should consult a doctor for examination and treatment.
One of the main tools doctors use of a vandladningsskema. Here shall be registered væskeindtag, vandladninger and cases of incontinence with the quantity and timing. The urge seen inkontinensen often just before urination. By structural disorders can be a constant siven of urine. It should also be aware of inappropriate væskeindtag, for example. large quantities until there was a period in which the child can not get to the toilet.
Another important tool isuroflowundersøgelse. This will be used specifically to differentiate between the functional causes of incontinence. Here the child pee in a special device, which measures the amount of urine per. second (flow). The device represents a trend in the vandladningen. This should normally be companulate. If there is overaktivitet in the bladder, the curve tårnformet (higher and steeper). To the contrary, is disturbed coordination between the bladder and lukkemuskel, the curve interrupted and thanks.
After urination can perform an ultrasound of the bladder to see how well the timber. If there is still urine over a certain amount of the bladder at the end of urination, blanking the ill. The remaining urine is calledresidualurin. Residualurin increases the risk of urinary tract infections . It performs an ultrasound if inkontinensen has been going on long, or, if there are other symptoms. urinary tract infection, pain or filling in the stomach. If there is suspicion of neurological or structural cause for inkontinensen, one should refer to a specialist who has experience with the explanation and treatment of these diseases.
Consideration of incontinence
Treatment consists of several elements:
- Advice and guidance: Tips for drinking and vandladningsvaner.
The child must learn to sit properly on the toilet and make themselves good time.
- Permanent vandladningstidspunkter. 3 each. hours whether there is vandladningstrang or not.
- If there is evidence urine back into the bladder after urination, the child must learn to let the water several times in a row. 2 or 3 times to ensure that the bladder empties the best possible way.
- Consideration of any. while constipation.
- Treatment of urinary tract infections with antibiotics.
In severe urge the above measures are not enough, it may be necessary to deal with drugs. Medicines belonging to the group of anticholinergics, which works by inhibiting sammentrækningen of blæremuskulaturen.
If inkontinensen caused disturbance in the coordination between blæremuskelsammentrækning and lukkemusklen during urination, can train the child to urinate with a relaxed bækkenbund. This is done with the help of a specialist nurse (uroterapeut).
The structural causes of incontinence, treatment is often surgery. If the cause is neurological disease, it may be necessary to use various other methods. You may deposit medicine (anticholinergics) in the bladder, stimulating the bladder through the electrical indoperede electrodes or empty the bladder regularly with a catheter.
Select and complications
One of the main complications of incontinence is urinary tract infection . If the bladder for a long time is crowded, muscular udspilet and less effective, resulting in a large lax and poorly functioning bladder.
The forecast for functional incontinence is very good, and the treatment has a major impact. Many will be completely healthy by itself or with treatment. The forecast is worse by neurological disease, while at the structural causes often depends on the outcome of kirurgien.