There are many causes of daytime wetting but dysfunctional voiding is the most common problem - 'voiding' means doing wee (passing urine).
Children with daytime wetting feel the urge at the last minute and may suddenly show holding postures or may 'curtsey' using their heel to stop the flow of wee. When they get to the toilet, the outlet valve may not relax fully. This stops the bladder from emptying fully. When they go back to their desk, the outlet valve will relax and wee leaks out. This leftover wee can also lead to infections. Doctors should ask all children with urinary tract infections if they have problems with daytime wetting.
Structural abnormalities in the bladder or the kidney tubes can also cause daytime wetting. Symptoms of this include pain while weeing, a poor wee stream or continuous dribbling wee.
Daytime wetting is rarely due to disease or child abuse.
Do
Don't
It is important that children with daytime wetting see a doctor with children's problems experience.
The doctor will take a detailed history of the problem and examine your child. A diary with the following information is very helpful:
Your family doctor may refer your child to a paediatrician (child health specialist) or urologist (a doctor specially trained in conditions of the bladder and urinary system).
If your family doctor suspects a psychological problem, they may refer your child for help in this area.
Your child may have laboratory tests on blood and wee to rule out any medical conditions. 50 percent of girls who wet during the day will have occasional bacteria in their wee.
Your child may need an ultrasound scan or x-ray to check the bladder and kidneys.
Occasionally a child may need cystoscopy. A urologist will so this. A urologist is a doctor specially trained in bladder and urinary system conditions.The urologist uses a tube to look for any abnormalities in the bladder outlet.
They may also do urodynamics - a test to see how the bladder and urethra are doing their job of storing and releasing wee.
Daytime wetting can be very distressing and dysfunctional voiding can last for a long time. (Voiding means passing wee).
10 to 15 percent of children with daytime wetting become dry each year.
You should be able to bring your child's daytime wetting under control with retraining, and occasionally, suitable medication.
The best approach is to encourage your child to pass wee on a timed basis before they feel the urge. This allows the bladder to empty while the outlet valve is still relaxed. It is important to individually tailor timed voiding for your child and family, especially if they are going to school.
Your child should try to relax and empty their bladder without straining. Sympathetic and energetic management that puts your child in control is best. Offering reminder alarms and sticker charts are often helpful strategies as the programme needs to continue for at least 6 months.
After doing wee (voiding urine), children count to 20 and try to empty their bladders again. This reduces leftover wee in the bladder.
Pelvic floor exercises and teaching control with relaxation of sphincter muscles can be helpful, but exercises that encourage holding on to wee make things worse.
Treating constipation is essential to reduce leftover wee in the bladder and stop blockage of the outflow.
Some medicines can be useful. Antibiotics control urinary tract infections and can reduce bladder instability. Antispasmodic drugs such as 'oxybutynin' do not result in long-term benefits by themselves but may help short-term to help with bladder retraining.
In most cases, surgery has limited success and may sometimes make the problem worse.
This content has been produced by the Paediatric Society of New Zealand in collaboration with the Enuresis Guideline Team, KEEA (Kiwi and Enuresis Encopresis Association) NZ and NZCA (The New Zealand Continence Association).
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This page last reviewed 15 December 2017.
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Links
[1] https://www.kidshealth.org.nz/bedwetting
[2] https://www.kidshealth.org.nz/node/1860
[3] https://www.continence.org.nz/index.php?mode=display_provider_regions&filter=children
[4] https://www.continence.org.nz/pages/Contact-Us/7/
[5] https://www.kidshealth.org.nz/node/1691
[6] https://www.parent2parent.org.nz/
[7] https://www.kidshealth.org.nz/node/1861
[8] https://www.childcancer.org.nz
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[10] http://www.health.govt.nz/yourhealth-topics/health-care-services/healthline
[11] http://www.healthline.govt.nz
[12] http://www.paediatrics.org.nz/
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