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Achieving urinary continence in children

Nature Reviews Urology volume 7, pages 371–377 (2010)Cite this article

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Abstract

Achievement of urinary continence is an important developmental step that most children attain with the assistance of their parents and caregivers. Debate continues as to the best time to toilet train; in some Asian and African cultures children are trained as infants, while training at age 2–3 years is more typical in Western cultures. Infant voiding is not merely a spinal reflex, as the sensation of bladder filling is relayed to the brain. However, the ability of the brain to inhibit bladder contractions, and to achieve coordinated bladder contraction with sphincter relaxation, matures over time. While there is a concern that later toilet training may be responsible for an increase in urinary incontinence in children, no controlled studies on early versus late toilet training exist to evaluate this hypothesis. A number of medical conditions such as spina bifida, posterior urethral valves, cerebral palsy and autism can cause incontinence and difficulties in toilet training. The decision to start toilet training a child should take into account both the parents' expectation of how independent the child will be in terms of toileting, and the child's developmental readiness, so that a realistic time course for toilet training can be implemented.

Key Points

  • While an infant can be trained to control voiding, independent toileting is usually achieved in children aged between 2 and 4 years

  • Animal and human studies suggest that bladder emptying is regulated by the brain from the time of birth

  • Significant changes in a child's bladder and sphincter function occur at approximately 18 months of age

  • No prospective clinical study has compared the effects of early versus late toilet training

  • A number of medical disorders can cause difficulty in achieving urinary continence; management may include behavioral therapy or anticholinergic drugs

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Acknowledgements

Charles P. Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.

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  1. Department of Urology, Stanford University School of Medicine, 300 Pasteur Drive, S-287, Stanford, 94305-5118, CA, USA

    Hsi-Yang Wu

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Wu, HY. Achieving urinary continence in children. Nat Rev Urol 7, 371–377 (2010). https://doi.org/10.1038/nrurol.2010.78

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