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Quick reference medical handouts used by Pediatric offices


Many Triggers Cause Daytime Wetting


Pediatricians are often asked to check a child who is either urinating frequently or wetting themselves in school. These youngsters do not complain of pain when voiding and usually have no problem with bladder control when sleeping. A check of the urine reveals no signs of infection or diabetes. The problem is mostly an inconvenience for the child. However, for the parents the problem can be infuriating, especially when the child must frequently visit the bathroom during meals or while driving in the car.

The most common reason for daytime wetting, particularly in boys, is holding their urine to the last possible minute. Children commonly become so engrossed in play activities that they ignore the bladder’s signal to urinate. These children often fidget, press their legs together, squirm while sitting, or adopt other postures that suppress the need to void. After several signals are ignored, however, the bladder no longer can be suppressed and an incontinent episode results.

Recently toilet trained children frequently begin wetting during the day after they lose the motivation to remain dry. During the toilet training process, youngsters are often rewarded with smiles and stickers for going to the bathroom. They enjoy the attention received from their parents. Soon, dry pants become expected by the parents and the child receives less attention for staying dry and forgets to go to the bathroom.

Some elementary school children with daytime wetting prefer not to use the bathroom at school, especially if a school bully is lurking about. Occasionally the school bus leaves before the child has had a chance to use the toilet or the trip home is too long.

Emotional stress is a frequent cause of daytime wetting. The incontinence may begin after a known stress, such as starting kindergarten or a new school, the death of a relative, or a family illness. Most of the time, however, incontinence due to stress has no readily identifiable cause. The common age-range for this reaction to stress is from ages four to twelve. If the cause of her stress is identified and eliminated, the problem usually disappears within weeks. If not, the frequency may persist for two to three months.

If the child is a girl, using bubble bath or heavily scented toilet paper can cause an inflammation of the urethra and produce daytime wetting and urinary frequency.

Constipation can also be associated with daytime wetting. It is thought that the pressure of the stool in the large intestines triggers a reflex in the bladder, causing the child suddenly to void during the day.

Occasionally, a child with urinary frequency will be found to drink a large number of drinks containing caffeine, which can cause this symptom. Certain soft drinks, such as Mountain Dew®, Dr. Pepper® and Sprite® are often associated with urinary frequency. Reducing the child's caffeine intake usually stops the frequency.

Ninety-five percent of voiding problems in children are functional. Having your child checked by their pediatrician and performing a urinalysis will usually identify the five percent that have a medical cause.

Treatment consists of reducing the youngster’s embarrassment and reducing the parent’s frustration. Parents often assume that their child’s daytime wetting and urinary frequency is due to laziness or silliness. Criticism and punishment will only prolong the problem. It will be important to reassure the child that there is nothing wrong with their body, and that they will gradually return to a normal pattern.

In a study of over 20,000 schoolchildren living in four continents, "wetting pants in class" was the third most stressful event mentioned, ranking only behind "losing a parent" and "going blind." Teachers can encourage the child to go to the bathroom at recess or between classes and will help to avoid the embarrassment of incontinence. Children should have a change of clothes at school and a plastic bag in which to store their wet clothes. Youngsters who hold their urine to the last minute should be encouraged to go to the bathroom immediately once they get the urge to urinate. Although the child might deny the need to void, parents should make it a rule that the child tries before going outside to play or leaving in the car.

With patience and positive reinforcement, the problem of daytime wetting will resolve over time. Parents should ignore the wetting and urinary frequency, they should not keep a record, and should stop talking about it. Understanding parents should do whatever they can to help their child relax until the problem resolves on its own.

 

As a reminder, this information should not be relied on as medical advice and is not intended to replace the advice of your child’s pediatrician. Please read our full disclaimer.

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