What is the pathophysiology of pediatric urinary incontinence?

Updated: Sep 23, 2019
  • Author: Sandip P Vasavada, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

Pediatric incontinence disorders are classified according to cause. Primary incontinence disorders generally are due to congenital structural disorders, including ectopic ureter, exstrophy, epispadias, and patent urachus. Secondary structural causes can result from obstruction from urethral valves, congenital urethral strictures, and large ectopic ureteroceles. In addition, trauma can result in secondary structural incontinence.

Neurogenic lesions make up the next category of pediatric incontinence disorders. These include spinal dysraphism, tethered spinal cord, and spinal cord tumors.

Nonstructural causes account for most cases of pediatric incontinence. [27] Infection and inflammation may be the source. Dysfunctional voiding habits can develop even at a young age. Some children may become so preoccupied with activities that voiding is delayed until capacity is reached and accidents result.

Some believe that certain children develop a pattern of not relaxing the pelvic floor while voiding. In some cases, this can be traced back to an infection or some other noxious stimuli. A vicious cycle of pelvic floor spasm, constipation, and urinary retention can develop.

So-called giggle incontinence has been thought to represent an underlying temporal lobe seizure. Other studies do not support this theory, however.

Vaginal voiding is a pseudoincontinence disorder, which may result from voiding with the legs held too tightly together. The impeded flow of urine may fill the vagina. The vagina empties when the child stands.

Nocturnal enuresis is the most common pediatric incontinence disorder. For discussion of this topic, see Enuresis.


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