Daytime Wetting

Key points to remember about daytime wetting

• daytime wetting happens in about 3% of healthy tamariki 
• about 67% of these tamariki will have bedwetting as well
• it is important that all tamariki 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
• be patient and stay positive - it takes a while to correct daytime wetting, but it almost always gets better with time

See the KidsHealth page on bedwetting for more information on wetting the bed at night

What causes daytime wetting?

There are many causes of daytime wetting.

Dysfunctional voiding

'Voiding' means doing wee (passing urine). 'Dysfunctional' means it doesn't function well.  Dysfunctional voiding  is the most common reason for daytime wetting.

Tamariki with daytime wetting, feel the urge to wee at the last minute. They 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 what they were doing, the outlet valve will relax and wee leaks out. This leftover wee sitting in the bladder can also lead to infections.

Doctors should ask all tamariki with urinary tract infections if they have problems with daytime wetting.

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?

Things you can do to support your child include: 

• 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 - tamariki  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 a 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

Things to avoid doing include: 

• growling your child for daytime wetting - they have no control over it 
• using 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 tamariki with daytime wetting see a doctor with children's problems experience.

The doctor will talk to you and your child about their daytime wetting and examine your child. A diary with the following information is very helpful:

• the times 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 for daytime wetting?

Your child may need to do a urine sample, and the doctor may also request a blood test. These can be tested to help rule out any medical conditions. For girls with daytime wetting, 50% of them will have occasional bacteria in their wee.

Your child may need an ultrasound scan or x-ray to check the bladder and kidneys. Occasionally the urologist will do other tests to look at the bladder and study how it works.

See the KidsHealth page on renal ultrasounds to learn more

How do you treat daytime wetting?

Daytime wetting can be very distressing for tamariki. Dysfunctional voiding can last for a long time. 'Voiding' means doing wee (passing urine). 

Between 10% and 15% of tamariki with daytime wetting become dry each year.

You should be able to bring your child's daytime wetting under control with some retraining and, occasionally, suitable medication. Panty liners can be helpful to reduce small amounts of wetting or smell.

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 tailor timed voiding to suit your child and whanāu (family), especially if they are going to school.

Some examples of times to encourage your child to wee include:

• when they wake up
• before going to school
• at school before class
• during playtime
• at the start and end of lunchtime
• after school finishes before going home 

Encourage your child 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), tamariki 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. Exercises that encourage holding on to wee make things worse.

Treating constipation

Constipation can make bladder control more difficult. Treating constipation is essential to reduce leftover wee in the bladder and stop the blockage of wee. 

See the KidsHealth page on constipation for more information 

Medicines

Some medicines can be useful. Laxatives are very useful to help empty the bowel. Antibiotics treat 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 in the short term to support bladder retraining.

Surgery

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