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Urinary and Genital Disorders (Children)

5year old day time wetting

05/27/2011

Question:

My 5 year old daughter is dry at night and has been since about 3 years old. However, although not continual she has periods when she wets herself during the day. She tells me she doesn`t feel that she needed to go - but she can have periods when she is dry for months and we have no problems. However, just recently she has started wetting herself during the day whilst at school and is increasing now to twice a week. She sometimes complains that she has a sore tummy but this doesn`t always link to the days she wets herself. Or am I just trying to find a connection somewhere! She has always tended to leave going to the toilet to the last minute.

Answer:

This is a fairly common issue around this age group. The most common cause for intermittent urinary incontinence and associated abdominal pain would be constipation. When the rectum is distended or even impacted with stool, it can push on the bladder (located right in front of the rectum) and cause an involuntary bladder contraction (termed "urge incontinence"). Sometimes the children will have a sudden, strong urge to urinate and not be able to make it to the bathroom in time. Other potential causes for urge incontinence at this age include bladder irritants in the diet such as caffeine, carbonation, chocolate (which has caffeine in it), and citrus (like orange juice), termed the "4C's".

A typical initial treatment plan would be to try an over the counter laxative appropriate for her age (such as glycolax), have her urinate on a timed schedule (every 2-3 hours), increase her daytime fluids (water is best), and avoid the 4C's as mentioned above. If there is no improvement or if she has had problems with urinary tract infections, discussion with the pediatrician regarding referral to a pediatric urologist for further evaluation may be appropriate. If she has a good response to this treatment regimen, then typically no further testing is necessary.

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Response by:

William Robert DeFoor, MD, MPH William Robert DeFoor, MD, MPH
Associate Professor of Surgery
College of Medicine
University of Cincinnati