Info for Professionals
Daytime wetting, or urinary incontinence, is defined ‘Leakage of urine in children over the age of 5 years which occurs at least once a week and where there are organic causes’ (Hjalmas 1992).
Most definitions of daytime wetting refer to the age of 5 as the age at which parents should seek a professional assessment and help to overcome the problem. ERIC suggests that parents should seek assessment when they begin to have concerns over their child’s daytime wetting.
Functional daytime wetting is often urge incontinence due to an overactive bladder ((Hjalmas 1992). Urinary tract infection and constipation are also factors to consider. At the age of 7 approximately 3% of girls and 2% of boys experience functional daytime wetting at least once a week.
In children aged over 5 an organic cause can be a neurological or urological abnormality such as urethral valves or sphincter incompetence, or it can be functional with no underlying anatomical or neurological problem. Less than 1% of daytime wetting is caused by organic causes but should always be assessed.
An assessment will include a
routine urine test and an ultrasound of the bladder and kidneys in the over
fives. The pattern of the wetting
accidents and any related emotional factors should also be assessed. A record chart is useful to
provide baseline information and monitor progress.
If there is no evidence of a urinary tract infection or signs of other abnormalities the treatment will include:
- drink at least 6-8 cups of water based fluid per day spread out over the day
take time to empty the bladder fully
- regular toileting routine
- use a prompt such as a vibrating wristwatch as a reminder.
- check the accessibility of drinking water and school toilets
It can take time for daytime wetting to resolve. In persistent a referral to a paediatric urologist or nephrologist may be necessary for possible
further investigations including urodynamic tests and cystometry to assess
bladder function. Some children benefit
from combining the general treatment strategies with antichiolinergic
medication such as oxybutynin.
Tips for resolving daytime wetting
accidents and nocturnal enuresis can have far reaching effects on self-esteem
and parent-child relationships. It is important to recognise that there are
known physical causes, so that families feel eager to adopt measures to help
2. Exclude urinary tract infection & constipation
This is important
in the initial assessment, especially if the child presents with sudden onset
of daytime wetting or secondary nocturnal enuresis (onset occurs after more
than six months of being dry).
3. Further investigations for daytime wetting in the over five year old
investigation is warranted in children who have had more than one urinary tract infection, or who are continually dribbling urine or have had
previous failed treatment. Renal scarring can result from recurrent urinary
4. Frequency and urgency in the day, without or without wetting, is a clinical identifier of bladder over-activity and a possible factor in nocturnal enuresis
Children with bladder
over-activity show variability in the size of the wet patch at night and may
wake during, or just after, wetting. The maximum voided volumes of these
children will be smaller than expected when measured in the day. This can be
measured when the child feels that the bladder is full (not the first morning
void). To calculate the expected bladder capacity for a child use formula: (Age
in years) x 30+30 ml. Bladder training and anticholinergic (antimuscarinic)
medication can help.
5. Assess what the child is drinking
It is helpful for the child to drink 6-8 cups of water based fluid spread across the whole day. Children and parents may need to be reminded of this.