Key points to remember about daytime wetting?

• daytime wetting happens in about 3 and a half percent of healthy children
• 67 percent of these children will have bedwetting as well - see bedwetting [1]
• it is important that all children with daytime wetting see a doctor who has experience with children's problems
• you will need to control daytime wetting before you can sort out bedwetting
• you will need lots of patience and support to correct this problem but a positive approach is usually rewarded by success

What causes daytime wetting?

There are many causes of daytime wetting but dysfunctional voiding is the most common problem - 'voiding' means doing wee (passing urine).

Dysfunctional voiding

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.

Some other causes of daytime wetting

• a twitchy or 'overactive' bladder which may lead to wet pants or urgency
• a weak outlet valve which may lead to wet pants when laughing, coughing or straining
• urinary tract infections
• constipation which can lead to wet pants as well as soiling
• problems with the nerves from the lower spinal cord - this may be associated with weakness in the legs

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.

What can I do to help my child's daytime wetting?

Do

• be patient and understanding - reassure your child, especially if they are upset
• respond gently if your child is wet even if you feel angry - they do not want it to happen either
• give your child plenty of fluid during the day - children may try to drink less to reduce the amount of wee but the slow bladder filling makes it harder to feel the bladder filling up and makes the problem worse
• avoid drinks with caffeine such as tea, chocolate and fizzy drinks
• teach your child to relax and take time when doing wee - girls should learn to wee with their legs apart and smaller girls may find a footstool helpful
• provide spare underwear or a panty liner for school - the smell of wee may embarrass your child and lead to teasing

Don't

• punish your child for what they can't control
• use nappies or plastic pants if your child is over 4 or is embarrassed

When should I seek help for my child's daytime wetting?

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:

• the time your child does wee
• the amount of wee they do
• how much fluid they drink

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.

What tests will my child need?

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.

How do you treat daytime wetting?

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.

Timed voiding

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.

Double voiding

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

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

Treating constipation is essential to reduce leftover wee in the bladder and stop blockage of the outflow.

Medicines

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.

Surgery

In most cases, surgery has limited success and may sometimes make the problem worse.