For children, bed-wetting, also known as enuresis, can happen during the night, day or sometimes both.
Daytime Incontinence VS. Nighttime Incontinence
Incontinence is a condition where you lose control of your bladder and wet yourself. Enuresis is when a child repeatedly urinates into their clothes or bedclothes. This can both be done voluntarily and involuntarily. While the average age for a child to be potty-trained in the United States is 4 years old, but enuresis can still happen after that age.
Nighttime incontinence, or nighttime wetting, is more common among children below the age of five and typically stops as they grow older.
Daytime incontinence, or daytime wetting, is not as common, which is why it should be taken more seriously. A 2016 study shows that 2-3% of school-age children struggle with it and is more common in girls.
Causes of Daytime Incontinence
If your child is potty-trained, it will come as a surprise if they start to wet themselves more often. This could be a sign of daytime incontinence. So what causes it?
Dysfunctional Voiding
The most common reason behind daytime incontinence is dysfunctional voiding. This is when your child is unable to fully relax their muscles to properly empty their bladder.
Overactive Bladder
Having an overactive bladder is the opposite of dysfunctional voiding. This is when your child constantly feels the need to pee, even if their bladder is not full.
Delayed Bladder Maturation
Delayed bladder maturation is when your child’s brain and muscles responsible for managing the bladder have not matured.
Urinary Tract Infections
A urinary tract infection (UTI), is an infection within the urinary system, which includes the kidneys, ureters, bladder and urethra. Symptoms in children include:
- Sudden need to pee (urgency)
- Need to pee often (frequency)
- Loss of control of urine (incontinence)
- Pain while urinating (dysuria)
- Trouble urinating
- Pain above the pubic bone
- Blood in the urine (hematuria)
- Bad-smelling urine
- Nausea and vomiting
- Fever
- Chills
- Pain in the back or side below the ribs
- Tiredness
Constipation
Constipation is a common risk factor for children with bladder problems. Constipation can affect the way the bladder works and/or worsen bladder symptoms. Constipation is also an independent risk factor for urinary tract infections. Typically, it results in your child having fewer than two bowel movements a week and/or bowel movement that is not characterized as type 3 or 4 on the Bristol Stool Chart.
Structural Abnormalities
Structural abnormalities are a more rare cause of enuresis, but they happen when there is something wrong in your child’s organs. This involves their urinary systems, muscles or nerves involved in urinary control.
Neurological Issues
Neurological issues around daytime incontinence include:
- Cerebral palsy
- Attention deficit disorder (ADD)
- Hyperactivity disorder (ADHD)
- Down syndrome
Psychological Factors
Most adults experience some level of stress and anxiety, and children can also experience these intense emotions. Stress and anxiety for a child could involve changes like a new school/environment, family dynamics and past trauma.
Common Symptoms
Common symptoms of daytime incontinence include:
- Frequent urination
- Sudden urges to urinate
- Inability to hold urine
- Wet underwear or clothing
- Hiding accidents
Treatment Options
There are a few options you as a parent or guardian can take to help your child struggling with daytime incontinence.
Behavioral Modifications
For some kids, relaxing while going to the restroom can be difficult. The way you can help is by reminding your child to not feel rushed when they are going.
Other modifications include setting up a schedule for them to pee at least every two to three hours during the day. This helps their body develop a regular cadence of going to the restroom. It also allows you to track how often they go. When they do use the restroom, it’s important to provide positive reinforcement or a reward system like a sticker board.
If you are considering going to your health care provider, keeping a bladder diary can be helpful. All you need to track is:
- Their liquid/water intake per day
- How often your child goes to the restroom
- How much they urinate
- How many daytime wetting incidents they have
- What they were doing at the time of the incident
Lifestyle Changes
Lifestyle changes include adjusting your child's eating habits. A fiber-rich diet can help prevent constipation. Make sure your child is having at least one bowel movement that looks like type 4 on the Bristol Stool Chart at least every other day.
Another change you want to make in your child’s life is increasing their water intake. This will promote more trips to the restroom. Also, avoiding caffeine and sports drinks can minimize bladder irritation.
Pelvic Floor Exercises
For children, there are pelvic floor exercises that can help with daytime incontinence. For example, deep belly breathing is a good exercise to work on with your child.
All you have to do is take a deep breath in, pushing your belly out, followed by releasing the air. This exercise targets the pelvic floor muscles. As a result, it helps reestablish the coordination between the urinary systems.
Medications
If you go to your health care provider, they may prescribe your child medications like oxybutynin. This helps with an overactive bladder.
Emotional Support for Children
Daytime incontinence is a condition many children face, but it’s something they don’t have to face alone.
Support at School
Communication with your child’s school is important. If your child has scheduled restroom breaks, make sure their teacher is aware and your child can access the toilets appropriately. On top of that, make sure your child has a change of clothes just in case.
Building Self-Esteem
As their parent or guardian, it’s important to remain patient and understanding when your child has an accident. Daytime incontinence can already be causing stress on a child. They might feel embarrassed around their friends, so continue to help build up their self-esteem with positive reinforcement on their progress.
Family Support
If there are changes within the family dynamics, like divorce, the stress could be linked to your child’s daytime incontinence. In this case, family therapy could be beneficial.
When to Seek Specialist Care
Sometimes daytime incontinence can go away over time, but if your child’s symptoms worsen, contact your health care provider immediately. Your child could be at risk of other complications, like a bladder infection.
Symptoms of a bladder infection include:
- Fever
- Pain or burning when urinating
- Cloudy, dark, bloody or foul-smelling urine
- Pain in the lower belly area or back
If treatment from your child’s pediatrician does not appear to be working, it is time to ask for a referral to a pediatric urologist.
Long-term Outlook
It can take several months to a year for your child to overcome daytime incontinence. This is why it’s important to continuously work with your child on their treatment plan. If the situation is addressed at an early stage, your child will experience other health benefits, as well as a good self-esteem.
Pediatric Care at University Health
At University Health, you’ll find expert pediatric urologists dedicated to helping kids with sensitive issues. Request an appointment by calling 210-358-KIDS.
