When parents begin potty training their children, occasional wetting comes with the territory. However, after potty training is mastered, parents are often confused as to whether their child should still be having daytime accidents. This uncertainty can lead to a delay in diagnosis and develop into a clinically significant pattern.
As with many other developmental milestones, the majority of children have voluntary urinary control by the age of 4. This is also the age that children start entering school and daytime wetting becomes a social concern. Unfortunately, due to its public nature, it is likely to bring embarrassment and ridicule from peers.
Daytime wetting falls into a spectrum of urological disorders known as lower urinary tract dysfunction. Though relatively rare, it is important to determine whether there is an underlying disease process. The vast majority of children fall into the category of functional incontinence (daytime wetting) in which no structural or neurological deficit can be identified.
There are typically four causes of functional daytime wetting, the most common referred to as “lazy bladder syndrome.” Kids have busy schedules and when left up to them going to the restroom isn’t penciled in. These children often only urinate two to three times a day, expanding their bladders over time to a point where they no longer have the normal urge to urinate. As the bladder reaches capacity, it contracts on its own, not allowing the child fair warning.
Typical scenarios include a child rushing to the restroom and not making it in time, or a sudden curtsey maneuver in the middle of an activity where the child squats or crosses legs to prevent urinating. Once these scenarios become constant, a pediatric urologist should be consulted.
During the initial evaluation, a thorough medical history with physical exam is essential.
Additional laboratory, radiographic and urodynamic testing may be ordered for certain patients. Determining a child’s daily voiding and bowel habits, fluid and caffeine intake, and posture during voiding is extremely important. The way children “poop” definitely affects the way they “pee” and often a diagnosis of constipation is made.
Once a diagnosis of functional urinary incontinence is made, a variety of behavioral modifications and medical treatments are available with excellent results. Behavioral modifications can range from simply limiting fluid intake to examining and modifying the position a child sits to void. Medical treatments can be used in conjunction with behavioral therapy and may include medications that relax the bladder, biofeedback therapy and agents to treat constipation.
Daytime wetting can have a serious impact on the child, family dynamics and peer relations. Parents worry about their child’s feelings and self-esteem, and at the same time feel angry and frustrated with the accidents. The key to success involves a motivated patient and family, and a supportive pediatric urologist all working together.
Anand V. Palagiri, MD, is a pediatric urologist with Mercy Children’s Hospital.