Urinary incontinence in children is a more common condition than parents realise. Most children who are incontinent suffer from daytime urinary incontinence (symptoms of urinary incontinence whilst awake during the day), nocturnal enuresis (bedwetting at night while asleep) or a combination of the two.

“Parents should take note and seek help if the symptoms are frequent and associated with urgency or begin to affect the child’s daily life”

While occasional incontinence is part of normal development, persistent urinary leakage beyond the age of five may begin to affect a child’s confidence, school participation, and psychological well-being. According to Dr Srihari Singaravel, Consultant Paediatric Urologist, Paediatric and Robotic Surgeon at Sunway Medical Centre, Sunway City, this is a highly manageable condition with the right guidance.  

“Globally, about 10 to 20 percent of children experience nighttime bedwetting, while 7 to 10 percent have daytime symptoms. So, it is not unusual and rarely an issue,” he explains. 

What Is Normal and Potential Red Flags for Parents to Take Notice  

Bladder control develops gradually as children grow. Most achieve daytime control between the ages of two and three, while nighttime dryness can take longer, sometimes up to seven years. Some children continue to wet the bed after age five, and this does not necessarily mean that anything is seriously wrong.

Bedwetting is common among school-age children, while daytime wetting is less common. Parents should focus less on comparing their child with others and more on whether symptoms are persistent, worsening or affecting daily life.

A common belief is that children wet the bed because they sleep too deeply. “However, for some children, the signal from the bladder does not reach the brain in time resulting in urinary incontinence,” Dr Srihari explains.  

This means a child may not recognise the need to urinate during sleep. Others may produce more urine at night due to hormonal patterns, or develop habits of holding urine during the day, which can make things worse. “These are functional issues rather than structural problems. The bladder is healthy but not yet fully coordinated,” he adds. 

Parents should take note and seek help if the symptoms are frequent and associated with urgency or begin to affect the child’s daily life, such as not being able to go more than an hour without having to go to the toilet or more frequent “accidents” at school or at home.

Other signs include constipation or recurring urinary tract infections which could also signal a far more serious issue. 

The Overlooked Link Between Bladder and Bowel 

One of the most important and often overlooked contributors is constipation.  

“The bladder and bowel sit very closely together and function as part of the same system. If the bowel is full, it can press against the bladder, reduce its capacity, and make it more overactive,” says Dr Srihari. 

This can lead to urgency, frequent urination, and incomplete emptying. In many cases, addressing bowel habits alone significantly improves urinary symptoms. 

Simple factors such as poor toileting posture can also play a role. Children whose feet do not touch the ground when sitting on the toilet may struggle to empty their bowels properly, which can indirectly affect bladder control. 

First Steps Parents Can Take at Home 

The good news is that many children improve with simple, consistent routines and habits rather than immediate medical treatment. 

Dr Srihari advises encouraging or reminding children to urinate regularly, about every two to three hours, avoiding prolonged “holding”, and ensuring adequate hydration earlier in the day can help. Reducing excessive fluid intake in the evening and maintaining good bowel habits through a balanced diet with enough fibre and fluids are also important. 

“These are small changes, but when done consistently, they can make a meaningful difference,” he says. 

When Medical Treatment Is Needed 

For some children, especially when symptoms persist or begin to affect their confidence, medical support is needed. Treatment depends on the pattern whether it happens during the day, at night, or both. 

For nighttime bedwetting, medication may be considered when the condition affects the child’s daily life such as school trips or sleepovers. “The medicine mimics the natural antidiuretic hormone, helping reduce urine production at night,” he explains. 

For daytime symptoms, treatment focuses on the underlying cause. This may include treating constipation or, if needed, medication to relax the overactive bladder. When both are present, daytime symptoms are addressed first. 

However, Dr Srihari emphasises that treatment is not one-size-fits-all. “We need to understand how the bladder is functioning before starting medication,” he says, noting that tools such as ultrasound, uroflow studies and bladder diaries may be used. 

A common approach to bedwetting involves three months of medication followed by a two-week break in between to assess progress. Many children improve within the first cycle, with most responding well within two to three cycles. 

Supporting Children Without Shame 

Beyond treatment, emotional support is essential. Children with incontinence may feel embarrassed or anxious, especially in social settings.  

“The first step is to remove blame. This is not something the child is doing intentionally,” says Dr Srihari.  

He encourages parents to focus on effort, keep routines calm, and avoid punishment which can increase stress. Teachers and caregivers can also help by allowing easy toilet access and maintaining a supportive, private environment.  

“Urinary incontinence is a medical and developmental issue, not a discipline problem,” he adds. With time, understanding, and the right support, most children improve significantly.  

 “Children need understanding, patience, and the right care instead of judgement,” he concludes

The medical information of this article is contributed by Dr Srihari Singaravel, Consultant Paediatric Urologist, Paediatric and Robotic Surgeon at Sunway Medical Centre, Sunway City.