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Urinary Incontinence in Children

Million people have problems holding urine until they can get to a toilet. This loss of urinary control is called "urinary incontinence" or just "incontinence." Although it affects many young people, it usually disappears naturally over time, which suggests that incontinence, for some people, may be a normal part of growing up. No matter when it happens or how often it happens, incontinence causes great distress. It may get in the way of a good night's sleep and is embarrassing when it happens during the day. That's why it is important to understand that occasional incontinence is a normal part of growing up and that treatment is available for most children who have difficulty controlling their bladders.
How does the urinary system work?
Urination, or voiding, is a complex activity. The bladder is a balloonlike muscle that lies in the lowest part of the abdomen. The bladder stores urine, then releases it through the urethra, the canal that carries urine to the outside of the body. Controlling this activity involves nerves, muscles, the spinal cord, and the brain.

The bladder is made of two types of muscles: the detrusor, a muscular sac that stores urine and squeezes to empty, and the sphincter, a circular group of muscles at the bottom or neck of the bladder that automatically stay contracted to hold the urine in and automatically relax when the detrusor contracts to let the urine into the urethra. A third group of muscles below the bladder (pelvic floor muscles) can contract to keep urine back.

A baby's bladder fills to a set point, then automatically contracts and empties. As the child gets older, the nervous system develops. The child's brain begins to get messages from the filling bladder and begins to send messages to the bladder to keep it from automatically emptying until the child decides it is the time and place to void.

Failures in this control mechanism result in incontinence. Reasons for this failure range from the simple to the complex.
Incontinence happens less often after age 5: About 10 percent of 5-year-olds, 5 percent of 10-year-olds, and 1 percent of 18-year-olds experience episodes of incontinence. It is twice as common in boys as in girls.
What causes nighttime incontinence?
After age 5, wetting at night--often called bedwetting or sleepwetting--is more common than daytime wetting in boys. Experts do not know what causes nighttime incontinence. Young people who experience nighttime wetting tend to be physically and emotionally normal. Most cases probably result from a mix of factors including slower physical development, an overproduction of urine at night, a lack of ability to recognize bladder filling when asleep, and, in some cases, anxiety. For many, there is a strong family history of bedwetting, suggesting an inherited factor.

Slower Physical Development:
Between the ages of 5 and 10, incontinence may be the result of a small bladder capacity, long sleeping periods, and underdevelopment of the body's alarms that signal a full or emptying bladder. This form of incontinence will fade away as the bladder grows and the natural alarms become operational.

Excessive Output of Urine During Sleep:
Normally, the body produces a hormone that can slow the making of urine. This hormone is called antidiuretic hormone, or ADH. The body normally produces more ADH at night so that the need to urinate is lower. If the body doesn't produce enough ADH at night, the making of urine may not be slowed down, leading to bladder overfilling. If a child does not sense the bladder filling and awaken to urinate, then wetting will occur.

Experts suggest that anxiety-causing events occurring in the lives of children ages 2 to 4 might lead to incontinence before the child achieves total bladder control. Anxiety experienced after age 4 might lead to wetting after the child has been dry for a period of 6 months or more. Such events include angry parents, unfamiliar social situations, and overwhelming family events such as the birth of a brother or sister.

Incontinence itself is an anxiety-causing event. Strong bladder contractions leading to leakage in the daytime can cause embarrassment and anxiety that lead to wetting at night.

Certain inherited genes appear to contribute to incontinence. In 1995, Danish researchers announced they had found a site on human chromosome 13 that is responsible, at least in part, for nighttime wetting. If both parents were bedwetters, a child has an 80 percent chance of being a bedwetter also. Experts believe that other, undetermined genes also may be involved in incontinence.

Obstructive Sleep Apnea:
Nighttime incontinence may be one sign of another condition called obstructive sleep apnea, in which the child's breathing is interrupted during sleep, often because of inflamed or enlarged tonsils or adenoids. Other symptoms of this condition include snoring, mouth breathing, frequent ear and sinus infections, sore throat, choking, and daytime drowsiness. In some cases, successful treatment of this breathing disorder may also resolve the associated nighttime incontinence.

Structural Problems:
Finally, a small number of cases of incontinence are caused by physical problems in the urinary system in children. Rarely, a blocked bladder or urethra may cause the bladder to overfill and leak. Nerve damage associated with the birth defect spina bifida can cause incontinence. In these cases, the incontinence can appear as a constant dribbling of urine.

What causes daytime incontinence?
Daytime incontinence that is not associated with urinary infection or anatomic abnormalities is less common than nighttime incontinence and tends to disappear much earlier than the nighttime versions. One possible cause of daytime incontinence is an overactive bladder. Many children with daytime incontinence have abnormal voiding habits, the most common being infrequent voiding.

An Overactive Bladder
Muscles surrounding the urethra (the tube that takes urine away from the bladder) have the job of keeping the passage closed, preventing urine from passing out of the body. If the bladder contracts strongly and without warning, the muscles surrounding the urethra may not be able to keep urine from passing. This often happens as a consequence of urinary tract infection and is more common in girls.

Infrequent Voiding
Infrequent voiding refers to a child's voluntarily holding urine for prolonged intervals. For example, a child may not want to use the toilets at school or may not want to interrupt enjoyable activities, so he or she ignores the body's signal of a full bladder. In these cases, the bladder can overfill and leak urine. Additionally, these children often develop urinary tract infections (UTIs), leading to an irritable or overactive bladder.

Other Causes
Some of the same factors that contribute to nighttime incontinence may act together with infrequent voiding to produce daytime incontinence. These factors include

a small bladder capacity
structural problems
anxiety-causing events
pressure from a hard bowel movement (constipation)
drinks or foods that contain caffeine, which increases urine output and may also cause spasms of the bladder muscle, or other ingredients to which the child may have an allergic reaction, such as chocolate or artificial coloring
Sometimes overly strenuous toilet training may make the child unable to relax the sphincter and the pelvic floor to completely empty the bladder. Retaining urine (incomplete emptying) sets the stage for urinary tract infections.

In homoeopathy we can treat the patient with urinary incontinence with folowing remedies according with symptoms:

Arsenicum Album
Acidum Phos.
Ferrum Phos
Kali Phos

Thank you,
Homoeopathic Dr. Saleem Hamid

  shamid on 2003-10-20
This is just a forum. Assume posts are not from medical professionals.

Ever since I can remember, my son had the habit of passing urine in trouser and according to him this is happening without his knowledge most of the time (at times he goes to the toilet and passes urine by himself). This happens mostly during day and only once in a blue-moon in night during sleep, when he is not well or so. Though we have been telling about this to his pediatricians, there advice was to wait and watch for sometime and to investigate further if not cured by itself later. Since he is now 8 years old and problem continues and as advised by our family physician, we had started consultations/investigations by way of sonography, x-ray, physical examinations etc.

The current diagnosis is NEUROGENIC BLADDER and have been advised to do “self Catheterization”. However on two previous occassions when Catheter was put for diagnostic purposes (Once for taking x-ray MICTURATING CYSTOURETHROGRAM & once for PVR, measuring capacity, blockages etc) he got severe UTI's- he did not had any UTIs before this for the last almost 8 years. As such this option looks to be very difficult and for the time being doctor has prescribed 'Urivoid 25 mg' tablets, which I have not found very useful.

Shall be grateful if you can advise the best homeopathic redeady.


tvrwarrier last decade
I have prescribed Arnica 30c in the wet dose for a similar case like your son and I was informed that it worked almost immediately.

You may like to give a teaspoonful to your son twice daily morning before breakfast and last thing at night.

I presume that you know how to prepare the wet dose.
Joe De Livera last decade
Hi Joe,

Thanks for your prompt response. If you remember, I have been communicating with you over your personal email on this subject. I had sent you an email on 15/9 asking for the exact mixture of this solution, as somewhere there is mention of puting one drop of Arnica 30c in 400/500 ml of spring water whereas somewhere it says 2 drops. However since I did not get any response I have started this medication since day before yesterday, alongside Cefpodoxime for UTI and Catheterization as and when necessary, as there is urine retention of even upto 250 ml at times.

Please advise two days is too small a period to have any improvement or should I try any other medicine.

Thanks indeed for all the assistance and advises being given by you continuously.


Warrier T.V.R.
tvrwarrier last decade
I deal with at least 15 cases daily both on the forums and here in Colombo and did not remember that I had prescribed for your son whose case interests me as I have never before handled a neurogenic bladder.

It would be wonderful if Arnica 30c in the wet dose can help him and it really does not matter whether you use 1 or 2 drops as long as you do not exceed 5 drops per 400ml water. Remember to shake the bottle up hard to ensure bubbling.

I note that you are skeptical about reporting in 2 days which you consider 'too small a period'.

You may however be surprised with the efficacy of this Arnica as my experience is that within the hour the patient feels the relaxing effect of the remedy which is how it helps the bladder by relaxing the muscles and permitting the full evacuation of the urine which should hopefully happen in your son's case.

One question to you is to inquire why you did not give him this simple remedy some days ago after I had prescribed it to you by email ?
Joe De Livera last decade
Hi Joe,

To reply your last question first (why I did not give him this simple remedy some days ago)the reasons are

- he was undergoing alopathic medicines as well as cateeterization twice daily and it would not have been possible to understand which medicine is acting.

- I am currently residing in a small place and getting the medicine etc is a problem.

- Also I was trying to get spring water but failed and is now using bioled water instead as suggested by you.

All the above factors contributed to the delay in starting the medication.

While on the subject is mineral water a better alternative to boiled water ?

I am not skeptical in reporting in 2 days. Since I did not notice much of a difference in his condition (as I mentioned in my previous post there was 250 ml of urine retention the day I started the Arnica therapy. However retneiton was only 30-40 ml yesterday) I was wondering whether 2 days is too small a period to show improvements. Please excuse me and I will keeping reporting his progress.

Thanks & regards,
tvrwarrier last decade
I am glad that you used the Arnica as prescribed by me and that you have already discovered that your boy's residual urine is down from 250ml to 30ml. It would interest me to learn after how many doses of Arnica did you observe the reduction of the retained volume.

You will note my statement on the action of Arnica in my last post which I shall copy below:

'You may however be surprised with the efficacy of this Arnica as my experience is that within the hour the patient feels the relaxing effect of the remedy which is how it helps the bladder by relaxing the muscles and permitting the full evacuation of the urine which should hopefully happen in your son's case.'

Please continue to give him a teaspoonful of the Arnica 3 times daily for the first few weeks and when he is stabilized you can then reduce the frequency to just twice daily.

Remember to always shake the bottle hard before you give him the dose.

Boiled water is OK as the chlorine in tap water is liberated with the boiling. You do not know what minerals are loaded in the so called mineral water.

Report your son's response daily on this forum.
Joe De Livera last decade
Hi Joe,

Ever since he had the UTI he was complaining about bladder pain while trying to pass urine, perhaps because of the force he had to use. Though the infection now is almost nil (Protein:Nil, Pus cells:1-2/hpf, earlier at he height of infection it was Protein: 1+, Pus cells: Plenty/hpf) he is still complaining of bladder pain at times while passing urine, especially in the morning. As usual he is still using some force to pass the urine and the stream is poor.

Any idea what could be the reason and any remedial actions please ?

tvrwarrier last decade
You are advised to follow the therapy that I have clearly indicated above.

Please note that you cannot possibly expect instant results although from your last post it amounted to almost that. The fact that your boy was able to pass urine with a residue of 30ml as against the usual 250ml shows that he is on the mend.

It is up to you his father to keep on with the therapy if you wish to see results.
Joe De Livera last decade
Hi Joe,

Arnica therapy as suggested by you is still very much being continued and will be continued in spite of the following.

Yesterday was a very bad day with lot of difficult in passing urine, bladder pain and and atlast a cateterization with a residue of almost 300 ml.

Today also it looks like is going to be a bad day as he is finding difficulty in passing urine and is complaining of bladder pain and later in the day may have to undergo another cateterization.

This is just to keep you updated.

Thanks & regards,

Warrier T.V.R.
tvrwarrier last decade
I am concerned at his progress yesterday and note that he had a residue of 300ml after voiding. How did you measure this quantity ?

Have you consulted a renowned homeopath in your city who will study the case carefully ?

It seems to me that you are faced with a vicious circle where he get an infection from the catheterization and he is still unable to void normally. At 8 years you will have to treat your son's problem seriously and my advice is to consult a homeopath who is well recommended in your city as it is essential that you do so ASAP in order to give your boy a fair chance in life.
Joe De Livera last decade
Hi Joe,

Catheterization is still being done at the Urologists clinic, as I am not confident/afraid to do it myself at home, and the measurement of 300ml was done by them and was shown to me as well.

Right now I am back from one of the better known homeopath's in my area and he has given some medicines (pills) till Friday (29/9) and I am supposed to report back to him. Since the local homepath's don't tell you about the medicines, I don't know what he has given.

According to him the medicines he has given now is more for the neuro problems and the treatment will have to be continued atleast for a period of 6 months. Also he has specifically mentioned that the current alopathic treatment (including antibiotics for infection and cateterization to take care of retention) should be continued for some more time and should not be stopped abruptly, which may aggravate the problem. This may be required till the homeo starts taking care of.

He has also suggested some natural remedies like sitting in lukewarm & cold waters alternatively, which may help in reducing retention.

I will keep you updated of the progress.

Thanks & regards,

PS: Excuse me for my ignorance - what you think could be the reason for bladder pain ? Could it be because of still prevailing infection or retention of higher quantity of urine ? This problem is a recent addition. Earlier problem was just limited to wetting the troucers few times a day due to overflow.
tvrwarrier last decade
I am glad that you have already taken your boy to a homeopath and I am surprised that he did not indicate the name of the remedies that he has given you. You have every right to inquire and I suggest you do so on your next visit.

You may like to know that in my case I always indicate the name of any remedy I give a patient on a sticker on the bottle of water and of course I do not charge a cent for the consultation and the remedy.

I believe that the reason for the pain in the bladder is because constant catherization can cause abrasion of the urethra especially if a larger size is used than can be tolerated by your sons urethra. This leads to an infection and you then have to use an antibiotic to treat it and the vicious circle is then created and it will take a lot of effort to overcome it.

He did not have the bladder pain as he was only wetting his trousers with the overflow and it was only after the frequent catheterizations that he started the bladder pain which is not good for his future development.

Please keep me posted with his progress and you boy will be in my throughts and prayers often.
Joe De Livera last decade
Dear Joe,

This is further to my earlier post.

As had mentioned earlier, I had been consulting a local homepathist and he was under medication. Recently we have observed some improvement in his condition as regards urine flow, bladder/muscle pain etc, though he is still having infection (In spite of giving Cipro for 2 weeks) and needs occassional catheterisation. I don't know what medicines he was giving, however from whatevber I overheard one of the medicines given were Causticum 200 or something (I heard him telling his assistant to give that medicine.

In the meanwhile we were also conducting investigations under analopathy doctor and the result of a Urodynamic Study conducted is:

'Detrusor shows severe degree overactivity. These features go on to explain his symptoms of urinary incontinence (which is of urge type) as well as nocturnal enuresis. His voiding study confirms a severe degree obstruction at the bladder outlet. This appears to be a case of dysfunctional voiding (Learned voiding dysfunction) of a typical type. However in the absence of significant sphincter interference, a mechanical cause such as Posterior Urethral valves should be considered.'

Next test advised is Cystography.

Any comments, recommendations, suggestions please ?


PS: In the meanwhile I had created a topic on 'Neurogenic bladder in children' and have been getting some responses. However these have not helped much (URL http://www.abchomeopathy.com/forum2.php/82841/)
tvrwarrier last decade
I am glad that your reported your son's progress after about a month.

His case is far above my ability to help and I do hope that the classical homeopaths who are now on this forum will use their experience to help your son.
Joe De Livera last decade

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Information given in this forum is given by way of exchange of views only, and those views are not necessarily those of ABC Homeopathy. It is not to be treated as a medical diagnosis or prescription, and should not be used as a substitute for a consultation with a qualified homeopath or physician. It is possible that advice given here may be dangerous, and you should make your own checks that it is safe. If symptoms persist, seek professional medical attention. Bear in mind that even minor symptoms can be a sign of a more serious underlying condition, and a timely diagnosis by your doctor could save your life.