Pediatric incontinence occurs when children over the age of 4 have difficulty controlling their urine and have leakage. It can occur at night or during the daytime. This can add additional stress to the child, their parents, and impact participation in social events. Physical therapy and occupational therapy can help with this in a variety of ways.  

Common symptoms associated with pediatric incontinence:

• Bedwetting (Enuresis): 

Urination during the nighttime can be caused from constipation, increased production of urine at night, and/or intake of bladder irritants prior to bed.

• Overactive bladder: 

This is a sudden and uncontrollable urge to urinate. Children may have accidents from not making it to the bathroom on time, and may often sprint to the bathroom to avoid an accident. 

• Dysfunctional voiding: 

Children may have difficulty fully emptying their bladder and may be contracting the muscles that need to relax during urination. This leads to less emptying with occasional leaking.

• Urinary urgency: 

Child may feel like they need to use the restroom frequently and without much warning.

• Voiding postponement: 

Often associated with a low number of voids per day. A typical child voids 4-5 times a day. This can be related to low awareness of need to void as well as purposeful withholding.

• Stress incontinence: 

This occurs when a small amount of urine leaks with exertion such as with playground activities. 

• Giggle incontinence: 

A complete void occurs during or immediately after laughing with normal bladder function when not laughing.

Physical or occupational therapists with pediatric incontinence training will meet with the child and their parent(s) and/or guardian to get a history of the current concerns. A physical examination is then completed to look at the muscles of the abdomen, legs, and back. The parent or guardian is present throughout the exam and the exam occurs over clothing. The findings of the exam are then sent to the referring physician to determine the most appropriate treatment plan for that child. Treatment sessions are one therapist to one child. They occur in a private treatment room with the children dressed and caregiver present. Our therapists incorporate a holistic approach that includes diet, sleep patterns, and other behavioral conditions that could be impacting the child’s continence. Our multidisciplinary team is able to collaborate to determine the best strategies for each child. These strategies may include:

• Core strengthening
• Biofeedback
• Bladder re-training
• Behavior and diet strategies
• Body awareness to help realize the urge to go
• Posture training
• Sensory strategies to assist with tolerance for public bathrooms and toileting
• Review of bathroom setup
• Bowel and bladder logs
• Increasing variety of foods and limiting bladder irritants
• Modified O’Regan Protocol

Biofeedback is a little machine that helps children learn to relax and contract their muscles that help them use the bathroom more efficiently. Little stickers are attached to their muscles and give feedback to a computer. This feedback is connected to a game that responds to the child’s relaxation or contraction of specific muscles. Biofeedback is commonly used for pediatric incontinence, but can also be used for body awareness to help strengthen specific muscles. Biofeedback sessions occur in a private treatment room with an adult caregiver present. 

We have a M.O.P. ( Modified O’Regan Protocol) specialist, Andrea Turnell, PT, DPT, on staff that can support your child’s M.O.P journey and assist in interpreting your process!