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Incontinence in Children

Understanding the Urinary System

Urination, or voiding, is a complex activity. The bladder is a balloon-like organ that lies in the lowest part of the abdomen. The bladder stores urine, then releases it through the urethra, which is 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 composed 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 also 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 matures. 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 simple to complex.

Incontinence in Children: Causes of Nighttime Bedwetting

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 are usually physically and emotionally normal. Most cases probably result from a mix of factors including:
  • Slower physical development
  • Overproduction of urine at night
  • Lack of ability to recognize bladder filling when asleep
  • Anxiety.
For many, there is a strong family history of bedwetting, suggesting an inherited factor.
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