September 3, 2010 / 9:18 PM / 9 years ago

Timer may help kids' bladder control problems

NEW YORK (Reuters Health) - Wearing a programmable wristwatch could help children manage their daytime bladder control problems, a new study suggests.

For children with urinary incontinence, the first approach to treatment is usually behavior modification - sometimes called bladder training or “urotherapy.” Tactics like changing drinking habits and taking scheduled trips to the bathroom can be effective, but often the challenge with children is getting them to stick with a routine.

When it comes to scheduled bathroom breaks, many children simply forget. So for the new study, Danish researchers looked at whether outfitting kids with a sports watch timed to go off at regular intervals would help.

They found that among 30 children who had not improved with standard urotherapy, adding the wristwatch allowed 18 (60 percent) to at least partly respond to therapy by the end of the 12-week treatment period. A partial response meant that the children reported a 50 percent to 89 percent reduction in their average number of “wet days” per week.

In contrast, only 5 (18 percent) of 28 children who stuck with standard therapy alone had a partial response, and none became completely continent.

Past studies have suggested that about half of kids with urinary incontinence can become “dry” with behavioral changes that typically include altering fluid intake, learning proper “toilet posture,” and scheduled bathroom breaks, noted Dr. Soren Hagstroem, the lead researcher on the current study.

These findings, Hagstroem told Reuters Health in an email, indicate that the timed bathroom breaks are “the crucial element” in this regimen.

They also suggest that “scheduled voiding is especially effective when the children have a timer watch to remind them to go,” said Hagstroem, of Aarhus University Hospital in Skejby, Denmark.

The study, published in the Journal of Urology, included 60 children between 5 and 14 years old with daytime urinary incontinence at least once per week, along with overactive bladder. Overactive bladder — a bladder that frequently contracts, often suddenly — is believed to affect most children with urinary incontinence, Hagstroem noted.

The children spent four weeks on standard urotherapy, during which time two became completely continent during the day. The rest of the children were then randomly assigned to continue with standard urotherapy alone or to start wearing a sports watch programed to remind them of their scheduled bathroom trips.

After 12 weeks, 60 percent of the 30 children in the wristwatch group had at least a partial improvement — including nine children who were completely “dry” based on their self-reports, one who reported at least a 90 percent reduction in wet days, and eight who were partial responders.

Moreover, the researchers found that seven months later, the nine children who were completely continent had remained so, and another seven had become continent. Six of those 16 children no longer needed to use their watches.

Kids may also grow out of urinary incontinence: according to the National Institute of Diabetes and Digestive and Kidney Diseases, about 10 percent of 5-year-olds experience incontinence but only 5 percent of 10-year-olds and 1 percent of 18-year-olds do.

According to Hagstroem, most children with overactive bladder and urinary incontinence can be treated without medications or surgery, which may be offered as options when behavioral changes fail.

Hagstroem recommended that parents try the wristwatch tactic to boost the chances that behavioral changes will work — if their child is at least 5 years old and the incontinence is not caused by an anatomical abnormality or a neurological disorder (which is the case for only a small number of children, the researcher noted).

The wristwatch did not appear to help, however, with bedwetting — a problem reported by most of the children in the study. None of the children in the wristwatch group showed an improvement in bedwetting during the 12-week treatment period.

That finding is “interesting” because behavioral therapy is typically recommended for nighttime urinary incontinence as well, according to an editorial comment by Dr. Tryggve Neveus of Uppsala University Children’s Hospital in Sweden published with the report.

Still, this study suggests that timed bathroom trips are a “crucial” part of urotherapy for daytime incontinence, writes Neveus. “Maybe we should recommend that the timer watch be included from the start and not as a later add-on in resistant cases.”

SOURCE: link.reuters.com/dyw98n Journal of Urology, online August 19, 2010.

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