Paediatric continence

Supporting children's continence health

Paediatric continence refers to the ability of children to control their bladder and bowel movements. This aspect of children's health is crucial as it directly impacts their daily lives, social interactions, and overall well-being. Paediatric continence issues can be distressing for both children and their families. Hence, addressing these issues promptly with appropriate medical guidance and support is vital.

In Lancashire and South Cumbria our children’s continence teams work to an overarching framework.

View the framework >>

Below is the service specification which outlines the requirements, standards and expectations for the children’s continence service. This document serves as a guide for both the provider and the commissioner, ensuring that the service is delivered consistently and meets the agreed standards.

View the service specification >>

Understanding paediatric continence

Continence is the ability to control urinary and faecal elimination. In children, achieving continence is a developmental milestone that varies in age but typically occurs between the ages of two and four years. The process involves the coordinated function of the bladder, bowel, and nervous system.

Continence issues are not uncommon in children, and they can manifest in different ways, such as:

  • Enuresis (bedwetting): involuntary urination during sleep in children aged five and older. It can be primary (child has never been dry at night) or secondary (child had a period of dryness but started wetting again).
  • Urinary incontinence: inability to control the bladder during the day, often leading to accidental wetting.
  • Constipation: difficulty in passing stools, which can lead to painful bowel movements and, in some cases, faecal incontinence.
  • Faecal incontinence (Encopresis): Involuntary passing of stools in inappropriate places, often related to chronic constipation.

Several factors can contribute to continence problems in children, including:

  • Physiological factors: such as urinary tract infections, anatomical abnormalities, or neurological disorders.
  • Psychological factors: stress, anxiety, or significant life changes can impact a child's continence.
  • Developmental delays: some children may take longer to develop the necessary control over their bladder and bowel.
  • Diet and hydration: inadequate fluid intake or a diet low in fibre can contribute to constipation and continence issues.

The diagnosis of paediatric continence issues typically involves a comprehensive evaluation, including:

  • Medical history: detailed history of the child's symptoms, diet, fluid intake, and any relevant family history.
  • Physical examination: conducted by a healthcare professional to rule out any underlying medical conditions.
  • Urinalysis: to check for infections or other urinary abnormalities.
  • Imaging studies: such as ultrasound, to assess the anatomy and function of the urinary tract.
  • Bowel diary: keeping a record of bowel movements, dietary intake, and any incontinence episodes.

Effective management of paediatric continence issues involves a multi-faceted approach, including:

Behavioural interventions

  • Toileting routine: establishing a regular schedule for bathroom visits to encourage timely elimination.
  • Positive reinforcement: using rewards and encouragement to motivate children to use the toilet.
  • Bladder training: techniques to increase bladder capacity and control, such as scheduled voiding.

Medical interventions

  • Medications: prescribed to treat underlying conditions or manage symptoms, such as anticholinergics for overactive bladder or laxatives for constipation.
  • Physical therapy: exercises to strengthen the pelvic floor muscles and improve bladder control.
  • Surgery: in rare cases, surgical intervention may be necessary to correct anatomical abnormalities.

Dietary and lifestyle modifications

  • Fluid intake: ensuring adequate hydration to promote healthy urinary and bowel function.
  • Fibre-rich diet: incorporating fruits, vegetables, and whole grains to prevent constipation.
  • Avoiding triggers: identifying and avoiding foods or drinks that may irritate the bladder, such as caffeine or artificial sweeteners.

Continence issues can be challenging for families to manage. It is important for parents and caregivers to have access to support and resources, here are some useful links below:

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