Pharmacologic therapies for the management of non-neurogenic urinary incontinence in children

ABSTRACT

Introduction: Non-neurogenic urinary incontinence in children is a common condition that affects the quality of life for both patients and parents. Symptoms may occur in the daytime, nighttime, or both and may be the result of structural and functional anomalies. Evaluation and management of associated co-morbidities, such as constipation is critical to management. Behavioral therapy is a fist line therapy in most cases of non-neurogenic urinary incontinence and pharmacologic therapy a second-line therapy.

Areas covered: In this review, the authors cover the pharmacologic agents, FDA approved and commonly used non-FDA approved, available for the treatment of four non-structural etiologies of non-neurogenic urinary incontinence in children. These include nocturnal enuresis, overactive bladder, giggle incontinence, and dysfunctional voiding.

Expert opinion: Non-neurogenic causes of urinary incontinence in children represent a complicated medical condition that requires both pharmacologic and non-pharmacologic management. Limited FDA-approved therapies as well as suboptimal results with approved therapies due to a lack in the understanding of the underlying pathophysiology and patient selection may lead to the use of alternative non-FDA approved therapies.

KEYWORDS:

• Pediatrics
• urinary incontinence
• nocturnal enuresis
• anticholinergic
• desmopressin
• tricyclic antidepressant

Article Highlights

• Behavioral therapy is a first-line therapy in nocturnal enuresis, overactive bladder and giggle incontinence.

• Constipation is common in children with urinary incontinence and should be assessed and managed to optimize treatment results.

• DDAVP tablets/melt are the most commonly used pharmacologic therapies for nocturnal enuresis.

• Anticholinergic agents are the most commonly used medical therapies for OAB, however, beta 3 adrenoceptor agonists and intra-detrusor injection of Botulinum Toxin A may play a role.

• Methylphenidate is the most studied drug therapy for giggle incontinence.

• The use of alpha blockers in dysfunctional voiding is not currently recommended by the International Children’s Continence Society.

This box summarizes the key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript has not been funded.