Diurnal enuresis (daytime wetting) is accidental wetting / peeing during the day. Most children outgrow this on their own. The amount of wetting during the day can vary from dampness to complete bladder emptying, requiring changes of clothes. Children may have urinary urgency (strong feeling to pee), urinary frequency (peeing every 15-30 minutes), urge incontinence (peeing on the way to the bathroom) and occasional dysuria (burning or pain with peeing) in addition to wetting. In some cases, children are initially dry but then begin to have daytime accidents. This is called secondary diurnal enuresis.

Daytime accidents for some children can be embarrassing and affect school performance and friendships.

How common is daytime wetting?

Daytime wetting is twice as common in females as it is in males and occurs in about 3% to 4% of children between the ages of 4-12 years old.

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, pooping less than three times a week. It may be hard for them to get out, painful and is large and dry for their age. They may complain of stomach pain.
• Holding it too long. You might notice the child will squirm, cross their legs, hold their thighs together, or use their hands to hold back the pee.
• A urinary tract infection
• Having a small bladder for their age
• Some medical conditions such as cerebral palsy, attention deficit / hyperactivity disorder (ADHD), or Down Syndrome.

How can I help my child overcome daytime wetting?

The most important thing you can do is be patient and understanding. Do not blame your child. Be positive and give support to your child. Punishment is not effective and could make the situation worse. 

If your child is having daytime urine accidents, try these steps:

• Create a schedule for your child to pee at least every two to three hours during the day, even if they do not 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 peeing. Breathing deeply or putting their feet on a stool while sitting on the toilet can help.
• Eating less 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.

What are the signs that we might need a doctor’s help?

You may want to take your child to the pediatrician for help if they have any of the following:

• Fever and having pain with going to the bathroom
• Blood in their pee
• 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 5 years of age and were previously dry for six to nine months
• Peeing too much (more than eight times a day)
• Not peeing often enough (less than three times per day)
• Uncontrollable urges to pee
• Recurrent urinary tract infections

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. Providers at this type of practice specialize in treating children who have problems with their urinary system.

Treatment 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 is a way for your child to learn how to relax their pelvic floor muscles so they can empty their bladder.

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.