Children develop at different rates. This involves not only walking and talking but also becoming dry. Bladder control is a maturation and learning process that needs time and lasts up to about the age of
Day- and night-time wetting in children – treatment
Urotherapy comes first
When they keep a bladder diary, many parents find that their child has a problem not only at night, but also has to go to the toilet very often and always very quickly during the day. Or the parents have to remind the child again and again to go to the toilet.
In many cases, it can be helpful when a few things are noticed and ways of behaviour are changed. For instance, the main drinking volume should be taken during the first half of the day and it should be ensured that the child goes to the toilet regularly. In the evening, children should not consume drinks containing caffeine or any carbonated drinks. And the bladder should be emptied fully in a relaxed manner before bedtime. The so-called “cart driver position” helps to relax the pelvic floor muscles so that the child can empty the bladder fully. Explaining what happens in the body and the specific problem, along with affecting changes in behaviour, should be appropriate for the child and this is called urotherapy. Urotherapy should precede all treatment measures.
Stool regulation is also important. Bedwetting can be eliminated successfully in over 50% of children by getting rid of constipation.
The "cart driver position"
In the "cart driver position" the feet are placed firmly on the floor or on a stool.
The legs are at an angle of 90 degrees. The upper body is slightly relaxed and leaning forward and the arms are supported on the thighs.
Show your child this relaxed sitting position on the toilet and practise it together a few times.
Motivating the child is important
An important step in treatment consists of awakening the child’s interest. The child must understand what the problem is and enjoy influencing his/her bladder. Certain times should be established together with the child when he/she should empty the bladder on command. This toilet training enables the necessary exchange of information between brain and bladder and promotes maturation of the pathways involved. The individual steps to full bladder control may be small but they should be recognised and rewarded.
Treatment of bedwetting
Medications for bedwetting contain a substance that resembles the body's own antidiuretic hormone and produce similar effects in the urinary tract. Urine production is reduced at night, the bladder can hold the urine volume in the night and wetting does not occur. However, it is important that this is discussed intensively with your doctor and his/her instructions are followed exactly. Only the doctor can determine the dosage of the medication and when the treatment can stop.
Alarm systems can also be used for treating bedwetting. Alarm pants or pads react to moisture with an alarm and wake the child so that he or she can go to the toilet independently. This training method requires a lot of discipline and persistence.
Treatment of daytime urinary incontinence
Drug treatment of childhood overactive bladder with bladder spasmolytics (anticholinergics/antimuscarinics) enables the bladder muscle to stretch better, thus increasing bladder capacity. In addition, urination intervals are prolonged. The duration of treatment varies greatly. Some children become dry quickly and others require longer treatment. It is important not to stop the treatment abruptly when it has been successful; withdrawal programmes have been established successfully for this purpose. Children must be continuously motivated and guided so that they do not suffer a setback.
For children who have the wrong toilet habits (such as "spluttering" urination), relaxation and tensing of their pelvic floor muscles can be illustrated visually and acoustically by special devices (biofeedback devices). The aim is for your child to learn to relax and tense the pelvic floor consciously. Biofeedback training should take place over several weeks and under the supervision of a specially trained physiotherapist.