Daytime wetting in children.
When should my child be dry during the day?
Daytime wetting or accidents (either little dribbles of urine or a full wetting episode) can be of social concern in children. Most children develop the ability to control voluntarily the act of passing urine by the age of 5 years before they enter school. However a number of boys and girls can present with problems with having little daytime accidents( wetting episodes) or a full blown wetting episode that soaks their clothes ( referred to as diurnal enuresis)
How should the urinary system normally work?
In babies and children who are not potty trained, signals from the bladder ( which stores urine) go to the lower portion of the spinal column and then back to the bladder to initiate a contraction of the muscle of the bladder and cause the child to pee. The act of peeing is dependent on the signals being received by the spinal column and brain, the contraction of the muscle of the bladder and the coordinated relaxation of the pelvic floor/sphincter( the tap) at the outlet of the bladder. As the child grows, the signals from the spinal column go up to the brain and the higher centres in the brain take control of whether or not it is the right time and place to pee. If it is, the child goes to the toilet in response to the sensation to pee and can make the bladder squeeze while simultaneously opening and relaxing the tap to allow the bladder to empty. Once this process is complete, the child remains dry and is said to be potty trained.
Why is my child wet?
In most cases of daytime wetting, children over the age of 5 years may be wet because there may be some problem with the way the mechanism described above is working. These problems are mainly functional which means there is nothing fundamentally wrong with the structure or circuitry of the urinary tract.
The mechanism of micturition ( peeing) works in two phases:
- Phase of bladder filling: this is when the bladder fills up with urine from the kidneys
- Phase of bladder emptying: This is when the bladder empties completely in a timely fashion. Normally children should pass urine about 6-8 times a day.
The phase of filling depends on the number of drinks taken during the day and this in turn will determine how many times the child passes urine during the day.
Children may be wet because of the way they behave or their bladder behaves during either of these two phases
Holders on: These children have the sensation to pee but hold on till the last minute and then have a tiny accident
Voiding postponement: These children need a pee but put this off and suddenly find themselves wet.
Overactive bladder: sometimes the bladder muscle itself squeezes prematurely and therefore the child may suddenly have the urge to go to the toilet and have an accident
Dysfunctional voiding: The child does not relax his/her pelvic floor( the tap) when peeing and hence does not empty the bladder
Constipation is also a big factor in causing the bladder to misbehave.
What are the symptoms to look out for?
The commonest symptoms are:
- Frequency- in holders on or voiding postponement, the child may do a jig indicating the need to
- Sudden episode of wetting – parents will typically say their child does not realise they need the
- Feeling the need to go again after having just peed.
- Problems with constipation.
What is the treatment?
The basis of any treatment is UROTHERAPY (A form of bladder retraining)
- The child must drink adequate amounts of fluids/day spaced out during the day.
- Avoid fizzy drinks which irritate the bladder.
- Pee regularly on a timed basis.
- Avoid constipation.
- Use of alarms to let the child know when they need to go to the toilet.
Most children are too preoccupied to go to the toilet regularly and need to be reminded. The mainstay of treatment is to get the child to retrain their bladder to work as described previously.
What is available for the bladder retraining?
Vibrowatches: These are normal watches that can be set to vibrate at preselected intervals. The vibration is discreet and reminds the child to go to the toilet even if they may not feel the need to.
Enuresis alarms: Used for bedwetting, these can also be used during the day. These have a sensor placed in the underpants connected by a tiny wire to a little box which alarms/vibrates/both as soon as the first drop of urine touches it.
You can read more information about urinary tract infections by downloading this document: Urinary tract Infection.
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