What is Daytime Wetting (Diurnal Enuresis)?
Daytime wetting is when a child who is toilet trained has wetting accidents during the day.
Some children who have daytime wetting also wet the bed. Learn more about bed-wetting.
How common is daytime wetting?
Daytime wetting (sometimes called “diurnal enuresis,” or “daytime urine accidents”) is twice as common in girls as it is boys. About 3 to 4 percent of children between the ages of 4 and 12 have daytime wetting. It is most common among young school-aged children.
What causes daytime wetting?
Many children who have daytime urine accidents have a parent or other relative who did, too. Other common causes of daytime wetting include:
- Constipation (stool in the colon can create pressure on the bladder and cause spasms, which lead to daytime wetting)
- Poor bathroom habits, such as not emptying the bladder completely or “holding it” for too long
- A urinary tract infection
Children with medical conditions such as cerebral palsy, Down syndrome and attention deficit / hyperactivity disorder (ADHD) may continue to have daytime wetting at a later age than other children.
How can I help my child overcome daytime wetting?
The most important thing you can do is be patient and understanding. Make sure your child knows that daytime wetting is a temporary problem, and that you are there to help.
If your child is having daytime urine accidents, try these steps:
- Create a schedule for your child to urinate at least every two to three hours during the day, even if she doesn’t feel like it.
- Use a sticker chart to track your child’s trips to the bathroom, and reward progress.
- Make sure your child is eating a healthy, fiber-rich diet and drinking lots of fluids. This can help prevent constipation, a common cause of daytime wetting accidents.
- Help your child relax and not rush while urinating. Breathing deeply or putting their feet on a stool while sitting on the toilet can help.
- Eating less of foods such as citrus fruits (oranges, lemons, grapefruits, limes), acidic fruits (pineapples, tomatoes), carbonated beverages, caffeine and chocolate. These can irritate the bladder, leading to nighttime urine accidents.
Be positive and give support to your child. Punishment is not effective and could make the situation worse.
What are the signs that we might need a doctor’s help?
It is not uncommon for children who are toilet trained to wet their pants from time to time. While frustrating and inconvenient, it is not necessarily a problem. However, a child with daytime wetting can have other symptoms which may affect their life in negative ways. You may want to think about taking your child to the pediatrician for help if they have any of the following:
- Daytime urine accidents for more than two or three days in a row
- Daytime urine accidents once a week for two months or more
- Are older than 4 years of age and were previously dry for six to nine months
- Urinate too often or not often enough
- Uncontrollable urges to urinate
- Small amount or trickle of urine when urinates
- Squats or grabs genitals to prevent urinating
- Experiences pain while urinating
- Has recurrent urinary tract infections
- Wets the bed
Children who have daytime urine accidents typically do not do so out of laziness, emotional problems or defiance. In fact, they often are embarrassed by it, and endure teasing. Children sometimes dread going to school or social activities because they fear having an accident.
The good news is that treatment is available. With encouragement, lifestyle changes and, in some cases, medical care, most children can overcome daytime wetting.
What tests will the pediatrician order for daytime wetting?
Your child’s pediatrician will provide a complete physical and run some simple tests to rule out problems such as diabetes or a urinary tract infection.
If these tests come back normal, the doctor may refer you to a pediatric urology practice for an evaluation. Physicians and nurse practitioners at this type of practice specialize in treating children who have problems with their urinary system.
What Are Treatment Options for Daytime Wetting?
Treatment options for daytime wetting include medication, biofeedback and healthy bowel habits.
Medication
Some medicines help relax the bladder and decrease bladder spasms. This can help the bladder hold more urine. Commonly prescribed medicines include Ditropan, Detrol and Enablex. Your child may need to take medicine for several months to years.
Biofeedback
Biofeedback can teach your child to how to relax their pelvic floor muscles so that they can empty the bladder completely while on the toilet. During biofeedback, a specially trained nurse places stickers on your child’s belly and buttocks. These are attached to wires that record muscle activity. The nurse uses video game-based exercises that your child controls using pelvic floor muscles. Biofeedback is most effective for children who are motivated and willing to do extra exercises at home, complete diaries and follow a schedule for urinating.
Healthy Bowel Habits
Having a soft bowel movement every day is very important in preventing daytime accidents. You can promote healthy bowel movements by making sure that your child:
- Eats a nutritious, fiber-rich diet. A good rule of thumb for how many grams of fiber your child should eat daily is to take your child’s age and add five.
- Drinks plenty of fluids during the day
- Goes to the bathroom around the same times every day
- Is relaxed when using the bathroom
Your child’s doctor may recommend stool softeners or laxatives to help ease constipation.
The Healthy Bladder Center at Cincinnati Children’s provides comprehensive treatment for children with daytime wetting issues. If your community does not have such a specialty clinic, consider taking your child to a pediatric urology provider.
