Daytime Accidental Wetting (Diurnal Enuresis)

Overview

Daytime accidental wetting (diurnal enuresis) may be a normal part of a child's growth and development, or it may be caused by a medical condition or by stress.

Daytime accidental wetting is more likely than bed-wetting to develop after a child has had bladder control for at least 6 months to 1 year (secondary diurnal enuresis). If daytime wetting is caused by a medical condition, such as an infection or a defect in the urinary tract, then treating the condition will usually stop the wetting. If it's caused by emotional stress, such as the birth of a new sibling, then the wetting often stops after the stress is addressed and managed.

Daytime accidental wetting is much less common than bed-wetting. But about 1 out of 4 children who wet the bed at night also wet during the day.^{footnote 1}

Understanding daytime accidental wetting

Daytime accidental wetting (diurnal enuresis) is common in younger children. Children may become so involved in play that they forget to go to the bathroom. Also, they may hold on to urine too long. These children:

• Tend to empty their bladders only 2 or 3 times a day compared with the normal 5 to 7 times a day.
• Often do not empty their bladders when they first wake up.
• Often do not empty their bladders completely when they use the bathroom.

Some children have accidental daytime wetting because they try to hold their urine too long. To keep from wetting themselves, children may:

• Squat.
• Squirm, cross their legs, hold their thighs together, or use their hands to hold back the urine.
• Stand very still, looking as if they will wet themselves if they move.

If a child has accidental wetting during the day, it can affect his or her performance in school or friendships. The child may be afraid of wetting at school or on outings. He or she may also be afraid of being teased by friends. Treatment can help the child lead a more normal life and have higher self-esteem.

When to call a doctor

Call your doctor now or seek immediate medical care if:

• Your child has symptoms of a urinary tract infection. These may include:
  • Pain or burning when your child urinates.
  • A frequent need to urinate without being able to pass much urine.
  • Pain in the flank, which is just below the rib cage and above the waist on either side of the back.
  • Blood in your child's urine.
  • A fever.

Watch closely for changes in your child's health, and be sure to contact your doctor if:

• Your child has any symptoms of diabetes. These may include:
  • Being thirsty more often.
  • Urinating more.
  • Being hungrier.
  • Losing weight.
  • Being very tired.
• Your child had bladder control but is wetting again.

Taking your child to the doctor

If you take your child to the doctor for help with the child's accidental wetting, a medical history and physical exam will be done to discover if the wetting is a symptom of a medical condition. The doctor will ask you and your child questions about the wetting, such as when and how often it happens.

As part of the physical exam, the doctor will examine the child's abdomen, rectum, spine, and genital area and may watch the child urinate. Depending on the results of the physical exam, the doctor may do other tests, such as:

• A urinalysis and urine culture and sensitivity test, if a bladder or kidney infection is suspected.
• An ultrasound, cystoscopy, intravenous pyelogram, or voiding cystourethrogram, if birth defects within the urinary system are suspected. Daytime wetting may be related to problems in the development of the urinary system.
• A urodynamic study, if a lack of nervous system control of the bladder is suspected.

Getting treatment

If a child has both daytime and nighttime accidental wetting, the doctor may treat daytime wetting first, because children normally gain daytime control over their bladders sooner than nighttime control. Accidental daytime or nighttime wetting may increase after treatment is stopped.

If daytime wetting is caused by a medical condition, then treating the medical problem may cause the daytime wetting to stop.

Treatment for daytime wetting that is not caused by another medical condition may include:

Medicine.

Oxybutynin (such as Ditropan or Oxytrol) may be used to treat daytime wetting in children and adults. It helps control the bladder muscle that releases urine.

Surgery.

If the child has daytime wetting that is caused by birth defects within the urinary system, surgery to correct the defect may be needed. But sometimes the surgery does not make the accidental wetting stop.

Counseling.

Sessions with a counselor may be helpful for the child who has accidental wetting that is caused by emotional stress. Counseling may involve psychotherapy or hypnosis (hypnotherapy). The goal is to reduce or help manage the stress or to prevent stress.

Caring for your child at home

• Encourage your child to go to the bathroom whenever he or she feels the urge.
• Praise your child for being dry. You may use hugs, stickers, or special treats as rewards.
• Be safe with medicines. Have your child take medicines exactly as prescribed. Call your doctor if you think your child is having a problem with his or her medicine.
• Don't make your child wear a diaper. That may make him or her feel like a baby. Wearing disposable underwear like Pull-Ups may help. But it may also make the problem last longer. This is because your child may have less reason to want to learn bladder control.

If your child delays going to the bathroom until he or she loses control and wets, there are some things you can try.

• Encourage your child to use the toilet. Do this when you notice signs that he or she may need to go. Your child may do things like squat, squirm, cross the legs, or stand very still.
• Offer more liquids to drink. Drinking more will increase how much urine is in the bladder. And this causes your child to need to go to the bathroom more often.
• Have your child go to the bathroom every hour during the day.
• Encourage your child to take extra time on the toilet. Doing this will make your child more likely to empty the bladder.