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Continence Program

Patrick H. McKenna, MD, FACS, FAAP, and Mercyhealth have established a regional center to treat urinary conditions including incontinence, daytime accidental wetting, bedwetting, urinary tract infections and vesicoureteral reflux. Urinary conditions treated include:

Urinary Incontinence

What is urinary incontinence?
Urinary incontinence is the loss of bladder control. It can range from occasionally leaking urine when you cough to having a strong urge to urinate and you are unable to get to the toilet in time.

Types of urinary incontinence

  • Stress incontinence: Urine leaks from the bladder when pressure is exerted such as sneezing, exercising, lifting something heavy or coughing.
  • Urge incontinence: A sudden urge to urinate and an involuntary loss of urine. Urination may be often or throughout the night.
  • Overflow incontinence: Frequent or constant loss of urine due to a bladder that doesn’t completely empty.
  • Functional incontinence: A mental or physical impairment such as arthritis, which delays you from making it to the toilet in time.
  • Mixed incontinence: More than one type of urinary incontinence.

Causes of urinary incontinence

Urinary incontinence can be caused by underlying medical conditions, physical problems or everyday habits. A physical examination will help your doctor determine the cause of incontinence.

Daytime Accidental Wetting (diurnal enuresis)

What is daytime accidental wetting (diurnal enuresis)?
When a child is toilet trained but has accidents during the day.

What are the signs that you should call the doctor?
It is not uncommon for children who are toilet trained to have daytime accidental wetting from time to time. Daytime accidental wetting may be a normal part of child development or caused by a medical condition. It is important to have your child evaluated by a doctor to determine if it could be caused from a medical condition.

How does the doctor evaluate daytime accidental wetting?
The doctor will take a medical history and perform a physical exam. Depending on the results of the medical history and exam, the doctor may do other non-invasive tests to determine the cause of daytime accidents.

What are common treatment options for daytime accidental wetting?
Depending on the medical history and the cause of daytime accidents, treatment options include medication; biofeedback therapy, a type of therapy used with electronics to help you learn about the body; and our 4-point elimination program focusing on nutrition and healthy bowel habits designed for your child.

Bedwetting (nocturnal enuresis)

What is bedwetting?
Bedwetting (nocturnal enuresis) is the nighttime release of urine by children older than 6. Almost all children who wet the bed have always wet the bed. Some children may have periods of nighttime dryness and then start wetting again.

How common is it?
Wetting the bed is a common problem. Approximately 20% of 6-year-old children experience nocturnal enuresis. It occurs more often in boys than girls. By the time they are 12 years old, 8 out of 100 boys and 4 out of 100 girls are still wetting the bed at night.

What causes bedwetting?
The cause is unknown. Recent studies suggest there may be many reasons for a child to wet the bed. Wetting the bed often runs in families. If one or both parents wet the bed when they were children, there is greater chance that their child will wet the bed. However, some children wet the bed even if neither parent did.

Although children who wet the bed are very deep sleepers, this is not a sleep disorder. It is unknown why children who wet the bed do not wake up when their bladders are full. This may be because the arousal center of the brain is slow to mature.

Diet can also play a role. For instance, we know that caffeine irritates the bladder. It also causes more urine to be produced. Constipation and infrequent bowel movements will also play a role in nighttime bedwetting. A large amount of stool in the rectum will push on the bladder, making the bladder smaller and making it contract before it is full.

Wetting the bed is not a sign of a mental problem. Children who wet the bed are not lazy or bad. They have little control over this problem, and they should not be punished. With patience, knowledge, and positive reward for success, bedwetting can be managed and controlled.

How is bedwetting treated?
Bedwetting may be treated by using alarm therapy or medicines. Parents and guardians should be given the information and education that will help them support their child. In many cases, your doctor or nurse will suggest treatment that may include all treatments.

Urinary Tract Infections

What is a urinary tract infection (UTI)?
A UTI happens when germs called bacteria get into the urinary tract, bladder or kidney that cause an infection.

What are the most common symptoms?
Babies and young children often have symptoms that do not seem specific to the urinary tract. Babies and young children may experience vomiting, loss of appetite and irritability.

Other symptoms include, but are not limited to, a frequent need to urinate, burning with urination, fever and foul urine smell.

How are urinary tract infections diagnosed?
Your health care provider may ask you questions about symptoms, complete a physical examination and collect a urine sample. The sample may be used for a urinalysis and a urine culture, if indicated. A urinalysis and culture are helpful to detect specific bacteria in the urine for treatment options.

How are urinary tract infections treated?
Most urinary tract infections are treated with antibiotics. It is important for your child to complete the entire course of medication as prescribed by the doctor. The medication duration and symptom improvement time depends on the illness, the child’s age, and the antibiotic prescribed. Encourage your child to drink plenty of fluids and empty the bladder frequently.

Vesicoureteral Reflux

What is vesicoureteral reflux?
Vesicoureteral reflux (VUR) is a condition that is most common in infants and young children. VUR occurs when urine flows backward from the bladder back into one or both of the ureters and sometimes the kidneys.

Doctors usually rank VUR as grade 1 to 5. Grade 1 is the mildest form of VUR, and grade 5 is the most serious form of the condition. VUR may cause urinary tract infections and sometimes kidney damage.

Most often VUR is found in children when they are 2-3 years old. It can be seen in babies or older children and usually affects more girls than boys. VUR is often diagnosed when a child has a urinary tract infection.

VUR is diagnosed with ultrasound of the abdomen and an x-ray of the bladder called a voiding cystourethrogram (VCUG).

Doctors treat VUR based on the child’s age, symptoms and grade of the VUR.

VUR will often get better and will go away as the child gets older. Antibiotics are used to treat UTIs and prevent kidney damage as the child grows. Surgery may be needed to correct an abnormal bladder or ureter.

Biofeedback Program

Biofeedback is a type of therapy used in pediatric urology. Biofeedback electronics help your child learn about their body.

The Biofeedback Program teaches your child how to relax the muscles used during urination. When children are unable to relax these muscles during urination, it may lead to problems that include urinary incontinence, urinary tract infections and voiding dysfunction.

During the biofeedback sessions, your child watches their muscle activity on a computer screen. This makes it easier to learn to control these muscles.

Biofeedback helps your child better understand how these muscles work and how to control them in a healthy way.

What happens during the session?

During each one-hour session, the specially trained registered nurse teaches your child how to how to find the muscles for urination, practice relaxing these muscles, and then play games using these muscles.

Special stickers (EMG patches) are placed on your child’s abdomen and buttocks. These patches measure muscle activity, which shows on the computer screen.

  • When your child’s muscles are tight, the computer readings are higher.
  • Likewise, when your child’s muscles are relaxed, the readings are lower.

Your child will be fully clothed during the session and sit in a relaxed setting, lying back in a chair.

You and your child will learn about the Elimination Program at earlier visits with your child’s provider. This will be reviewed during a part of each session.

How long is the program?

Typically, muscle relaxation is learned in about eight one-hour sessions. Most of the muscle relaxation is learned at home by practicing every day.

Progress in the program is checked at each session. Your child is given five-minute exercises to finish many times a day at home.

The Biofeedback Program must be practiced every day at home in order for your child to be successful. Some children might need additional sessions.

Once your child completes the program, they will be scheduled for four refresher sessions throughout the next calendar year.

How parents can help

Parents or guardians are very important coaches at home.

  • It is important to help your child with each part of the program from the Pediatric Elimination Program, to finishing their exercises, and giving your child support.

We ask both parent/guardians be at your child’s first biofeedback session if possible.

  • The first session sets the foundation of the program and expectations for success.
  • Please try to make other arrangements for your child’s siblings during all sessions. Siblings can be very distracting.

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