The urinary system is a complex system that consists of the kidneys, ureters, bladder, urethra and urinary meatus. The bladder is like a sponge, about the size of a small apple, but can double in size when full. It is the bladder that contains the urine that is ejected through the urethra and the urinary meatus. When the bladder contains about the size of a glass of water, the sensation of urination is felt.
Urinary incontinence is the involuntary loss of urine through the urethra. This problem of bladder leakage is quite common and mainly affects women, although men are not exempt. In children up to the age of 5 or 6 (when they are fully toilet trained during the day and at night), the term incontinence is misused because they do not have full control of their sphincters. It is more appropriate to talk about urine leakage during the day and enuresis at night.
Incontinence in adult women
In the most frequent cases, urinary incontinence affecting women is called “stress urinary incontinence” (jumping, lifting, physical activity increasing abdominal pressure, coughing, laughing).
It can occur at any age and results from a weakening of the pelvic muscles. Its causes are generally due to :
l A multiple pregnancy or a difficult childbirth having caused perianal lesions;
l Genital prolapse (also called organ descent);
l After any surgery of the lower abdomen or pelvis.
Infections such as acute cystitis or acute pyelonephritis can cause the bladder to become overactive and lead to incontinence problems.
Certain hygienic and dietary measures, such as a healthy, balanced diet rich in fiber, as well as physical activity can greatly improve urinary incontinence problems.
Which doctor to consult?
If the incontinence problem is viral or bacteriological, causing cystitis or pyelonephritis, your doctor is the first health professional to consult. The urologist is the specialist of the urinary tract, and is indicated when no improvement is found in spite of the various treatments proposed.
In the case of a mechanical incontinence problem, the attending physician is the best person to talk to. He will guide you and invite you, depending on your case, to consult a urologist, a gynecologist (especially for pregnant women and young mothers) and a midwife for perineal reeducation sessions (which can be taken, regardless of the patient’s age).
Incontinence in children
Before the age of 5 or 6, it is inappropriate to talk about incontinence. Bladder weakness or enuresis is considered normal. If the child has had previous episodes of bedwetting, the term secondary incontinence is used.
Generally, parents think that a child who is 3 years old (kindergarten age) should be clean. However, their urinary system may still be immature.
There is no need to worry until the child is 5 years old. After that age, more attention should be paid.
The causes of incontinence in children are rarely mechanical, but often psychological
The first cause is the immaturity of the urinary system. The child does not feel that he/she wants to pee. Patience is the only thing to do (as well as several pairs of absorbent sheets and mattress covers).
Psychological factors are very important to consider: sometimes a child will need to remain in the “baby world”; if the family is growing, for example, or if he or she has relationship problems at school or with family members.
“Peeing himself is an unconscious way for him to say that he feels vulnerable.
What health care professional can help?
In the case of a child, the pediatrician is the most appropriate. Generally, he has known the child since birth.
If the problems are psychological, the child psychiatrist can take charge of the child and help him or her gain self-confidence and “grow up”.
Finally, for children who are old enough, the physiotherapist will suggest sessions to improve control of the perineum, and thus better management of urination.