Children’s Continence: A Comprehensive Guide for Parents

As providers of a Children’s Continence Service, we recognise the challenges faced by children and their families in dealing with continence issues. Our primary focus is to offer assistance and guidance so that children can lead healthy, active lives. By designing targeted management plans that address specific needs, we strive to empower children in overcoming continence and other pelvic health challenges.

As children begin to develop bladder and bowel control, it is not uncommon for them to experience setbacks. Our skilled and compassionate team of healthcare professionals is here to help identify the underlying reasons behind continence and other pelvic health problems and utilise a range of approaches to tackle them effectively.

Understanding that continence issues can have a significant impact on a child’s emotional wellbeing and self-esteem, we are committed to fostering a supportive environment that ensures children and teenagers feel comfortable and the whole family unit feels supported in tackling the issue. With evidence-based strategies and personalised care, our goal is to enable every child to overcome continence challenges and flourish in all aspects of their lives.

Understanding Children’s Continence

We know that children’s continence can be a difficult topic to discuss, but it is important to understand the various aspects of this issue to offer the right support. In this section, we will provide a brief overview of children’s continence, its causes and types.

Children’s continence refers to a child’s ability to control their bladder and bowel movements. It is a developmental process that usually begins at an early age, with most children gaining continence by the age of five. However, some children may experience difficulties with continence, leading to problems such as bedwetting, daytime wetting, soiling and constipation.

The causes of continence issues can be varied and often multifactorial. They may include:

• Developmental delays or medical conditions
• Difficulties with communication between the nervous system and the bladder or bowel
• Behavioural or emotional factors
• Challenging or difficult toilet training experiences

However most children who wet the bed have no significant underlying physical or emotional problems.

There are several types of continence issues in children, such as:

1. Nocturnal enuresis (bedwetting): This is when a child, aged five to seven, or older, wets the bed. Bedwetting can be classified as primary (when the child has never been dry at night) or secondary (when the child has been dry at night for at least six months and then starts wetting the bed again).
2. Daytime wetting: This refers to involuntary urination during the day in children aged five or older.
3. Constipation and faecal incontinence: This occurs when a child has difficulty passing stools or experiences soiling.

In addressing continence issues, it is crucial to identify the underlying cause and provide appropriate interventions. Interventions can include behavioural techniques, education, electrotherapy, real time ultrasound, and in some cases, medication or referral to a specialist. Early intervention and support from healthcare professionals are key to helping children and their families overcome these challenges.

Why a Continence Service is Essential

As physiotherapists with specialised training and expertise in the field of paediatric continence, we understand that providing a comprehensive Children’s Continence Service is essential for a multitude of reasons. To begin with, continence issues can significantly impact the everyday lives of children and their families. By offering specialised support, we can help minimise the physical and emotional toll that these problems may cause.

Moreover, early intervention is crucial in preventing long-term complications and promoting a healthy lifestyle. Through our Children’s Continence Service, we work closely with families, healthcare professionals and educational institutions to identify and address continence concerns at the earliest possible stage.

We recognise that each child’s situation is unique, and so our service is tailored to accommodate individual needs. By utilising a personalised approach, we can efficiently target the specific issues faced by each child, ensuring optimal outcomes and fostering a greater sense of wellbeing.

Through our expertise and ongoing collaboration with other professionals, we remain at the forefront of evolving evidence-based practices. This enables us to continuously adapt and refine our methods, ensuring that children receive the highest quality of care and the most up-to-date treatments available.

In summary, a Children’s Continence Service is essential for promoting better health outcomes, addressing individual needs, and contributing to the wellbeing of children and their families. By investing in these services, we can make a real difference in the lives of those affected by continence issues.

Components of a Children’s Continence Service

Assessment Procedures

In our Children’s Continence Service, we first conduct a thorough assessment to evaluate each child’s unique needs. We gather detailed information about the child’s medical history, current symptoms, and daily habits, such as fluid intake and toileting routines. Our team uses non-invasive assessment techniques including use of real time ultrasound to assess bladder residuals, screen for constipation and pelvic floor dynamics.

Treatment Approaches

Our multidisciplinary team employs a range of evidence-based treatment approaches to address each child’s specific continence issues. Depending on the identified causes and contributing factors, we may recommend one or more of the following strategies:

• Behavioural interventions such as bladder training, drinking programs, scheduled voiding, and toilet positioning
• Pelvic floor muscle exercises to strengthen and/or relax essential muscles for bladder and bowel control
• Biofeedback to help children visualise and gain better control of their pelvic floor muscles

We closely monitor the progress of each child and work with other health care providers such as Paediatricians to adjust treatment plans and ensure the most effective and comfortable approach.

Long-Term Support

Understanding that continence issues may require ongoing management, our Children’s Continence Service focuses on providing long-term support for both children and their families. We are committed to establishing a strong foundation for continence management, and our team collaborates closely with parents and caregivers to ensure they are well-informed and confident in implementing strategies at home. We also connect families with local support groups and offer access to educational resources to promote sustained success in managing continence issues. Regular follow-up appointments help us monitor each child’s progress and adjust treatment plans as needed to optimise their quality of life.

The Role of Continence Physiotherapists

As Pelvic Health Physiotherapists, our primary responsibility is to assess, diagnose, and treat children experiencing bladder and bowel dysfunction. We focus on creating tailored interventions to help improve children’s continence and quality of life. Our work often involves collaboration with multidisciplinary teams, including paediatricians, urologists, gastroenterologists, occupational therapists, psychologists and nursing staff.

We utilise a range of evidence-based approaches to provide comprehensive and holistic care for each child. These may include pelvic floor muscle training, biofeedback, behavioural modification, and constipation management. Our treatment plans are carefully designed to meet the unique needs of each child while considering their age, developmental stage, and individual circumstances.

Education plays a significant role in our practice. We provide parents and carers with the necessary information and resources to better understand their child’s condition and effectively support them at home. This may involve teaching proper toileting techniques, offering guidance on fluid intake, and recommending dietary modifications.

Our expertise extends beyond direct treatment, as we also contribute to service development, and quality improvement initiatives. By staying up to date with current evidence and best practices, we continuously strive to ensure that our services meet the highest possible standards.

Holistic Approach and Multidisciplinary Collaboration

Role of Schools

In our approach to the Children’s Continence Service, we understand the importance of a holistic, multidisciplinary collaboration. This includes the critical role schools play in supporting children with continence issues. Teachers and school staff can help identify and address concerns early on, working with parents and healthcare professionals to develop tailored care plans. We encourage open communication among all parties to ensure comprehensive support.

At schools, we advocate for:

• Awareness-raising about continence issues and their impact on children’s wellbeing.
• Providing a safe, inclusive environment for affected children, ensuring they have access to appropriate facilities.
• Promoting healthy habits like timely toilet breaks, proper hydration and balanced diets among all students.

Parental Involvement

Parents play a central role in our approach to the Children’s Continence Service. We believe that strong parental involvement is vital for a child’s successful management of continence problems. We encourage parents to:

• Actively engage with healthcare professionals and school staff to understand their child’s needs and create individualised care plans.
• Provide emotional support and reassurance to help their child build confidence in managing their continence issues.
• Learn about the available resources and treatments to make informed decisions regarding their child’s care.

Paediatrician Support

Support from a Paediatrician or dedicated General Practitioner is essential in the holistic, multidisciplinary approach to the Children’s Continence Service. With their expertise they help to:

• Identify and diagnose continence issues in children.
• Work closely with families and schools to develop tailored care plans that address both the physical and emotional aspects of continence problems.
• Monitor the child’s progress and adjust treatment plans as needed.

By fostering strong collaborations among schools, parents, and doctors, we can provide comprehensive support for children dealing with continence issues, helping them lead healthier and happier lives.