Urinary Incontinence

Dear Lisa,

Nurse, for much of the past few years, my daughter, 20 has been wearing adult diapers for incontinence reasons. The problem has been resolved but she still insists on wearing diapers. Is there a psychological reason behind this? Should I seek professional help? Thank you.

Dear “Should I seek psychological help?”

Urinary Incontinence can be a very embarrassing situation for a child, especially if it persists into the teenage years. The stress of having to deal with the problem may have left your daughter emotionally dependent on the diapers, even though she does not need them anymore. My first concern would be that your daughter may still be having incontinence. She is a young adult now who is able to take care of herself, so it is possible that she still is having symptoms and may be too embarrassed to tell you. If your daughter in the past only had symptoms at night, I would be less suspicious that there is a physical problem. If your daughter had a problem with daytime incontinence as well as nighttime problems this may be indicative of a urologic problem or another medical condition. The good thing is that most children don’t have another problem and only less than 3 % of children with primary nocturnal enuresis (nighttime urinary incontinence) have urologic abnormalities.

You should talk to your daughter and explain to her that other conditions may lead to urinary incontinence and it is important for you to know if she is still having problems. If she is still having incontinenece, then certain medical conditions should be ruled out. Children with Attention Deficit Disorder and Sleep Apnea tend to be at risk for nighttime wetting. A child with Spina Bifida Occulta, which may present as a mole, dimple or hairy tuft on the lower back can lead to lack of sensation in the area leading to incontinence . (1) Other disorders of the spine including a tethered spinal cord or a mass can also lead to urinary incontinence. Constipation has also been associated with incontinence because a full rectum can restrict the bladder’s expansion and cause an automatic bladder contraction leading to incontinence.(1,2)

Some literature states that certain foods or additives have been implicated in contributing to urinary incontinence. These foods include caffeine, vitamin C, citrus juices, carbonated beverages, and sugar substitutes. (3) If you daughter is continuing to have incontinence it would be a good idea to keep a food diary to see if the episodes are related to the increased intake of items on this list. Medications may also be the culprit. Certain antidepressant medications and antihistamines may also cause wetting at night. (2)

If your daughter admits to continued symptoms an evaluation by a Urologist would be in order. If she already had a complete medical work up to rule out other causes for her urinary incontinence and she truly is no longer having symptoms then she will need help letting go of the diapers. Some children/young adults just need a little direction in regards to how to master this. Because she is a young woman it would be feasible to start by substituting a large sanitary napkin for the diaper. Each week purchase a brand that is smaller and thinner until she is using panty liners. This slow approach may be what she needs. If she is resistant to any change and insists on wearing adult diapers even though she doesn’t need them, then she may benefit from professional counseling by a trained Psychologist.

I wish you and your daughter well.

(1)Zacharycuk C. Psychosocial implications of nocturnal enuresis demand treatment. Infectious Diseases in Children.2006(Apr)72-73.
(2)Mercer, R. Dry at Night. Advance for Nurse Practitioners. 2003(Feb):26-30.
(3)Maizels M. Rosenblum D. Keating B. Getting to Dry: How to Help Your Child Overcome Bedwetting. Boston, Mass:the Harvard Common Press. 1999.

Lisa Kelly R.N., P.N.P., C.
Certified Pediatric Nurse Practitioner

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