Daytime Accidental Wetting (Diurnal Enuresis)

Topic Overview

Daytime accidental wetting is much less common than bed-wetting. But about 1 out of 4 children who wet the bed at night also wet during the day.^{footnote 1}

Knowing the cause of the wetting will help you and your child's doctor decide on the best treatment. Daytime accidental wetting is more likely than bed-wetting to develop after a child has had bladder control for at least 6 months to 1 year (secondary diurnal enuresis). This pattern of wetting is often related to a medical condition, such as an infection or a defect in the urinary tract, or emotional stress. Treating the condition will usually stop the wetting. But daytime wetting can be a matter of normal development, with no medical cause.

If daytime wetting begins after a child has had consistent bladder control, consider the possibility that stress, such as the birth of a new sibling, is the cause. Accidental wetting often stops after the stress is addressed and managed. Some children may benefit from seeing a mental health professional.

Daytime wetting as a part of normal physical development

Daytime accidental wetting (diurnal enuresis) is common in younger children. Children may become so involved in play that they forget to go to the bathroom. Also, they may hold on to urine too long. These children:

• Tend to empty their bladders only 2 or 3 times a day compared with the normal 5 to 7 times a day.
• Often do not empty their bladders when they first wake up.
• Often do not empty their bladders completely when they use the bathroom.

Some children have accidental daytime wetting because they try to hold their urine too long. To keep from wetting themselves, children may:

• Squat.
• Squirm, cross their legs, hold their thighs together, or use their hands to hold back the urine.
• Stand very still, looking as if they will wet themselves if they move.

If a child has accidental wetting during the day, it can affect his or her performance in school or friendships. The child may be afraid of wetting at school or on outings. He or she may also be afraid of being teased by friends. Treatment can help the child lead a more normal life and have higher self-esteem.

When to call a doctor

Daytime accidental wetting may be a normal part of a child's growth and development, or it may be caused by a medical condition. Getting your child's problem evaluated by a doctor is important if there is any chance that a medical condition is the cause.

Call the doctor if:

• Your child has signs of a bladder or kidney infection, such as:
  • Cloudy or pink urine or bloodstains on underclothes.
  • Urinating more often than usual.
  • Crying or complaining when urinating.
  • Urge to urinate frequently but usually passing only small quantities of urine.
• Your child is leaking (dribbling) when urinating or has a weak urine stream. The child may have a birth defect in the urinary system.
• Your child age 4 or older is having daytime accidental wetting and is leaking stool. The child may have stool blocking the intestines, caused by having constipation over a period of time.
• Your child had bladder control but is wetting again.

Evaluating daytime accidental wetting

If you take your child to the doctor for help with the child's accidental wetting, a medical history and physical exam will be done to discover if the wetting is a symptom of a medical condition. The doctor will ask you and your child questions about the wetting, such as when and how often it happens. As part of the physical exam, the doctor will examine the child's abdomen, rectum, spine, and genital area and may watch the child urinate. Depending on the results of the physical exam, the doctor may do other tests, such as:

• A urinalysis and urine culture and sensitivity test, if a bladder or kidney infection is suspected. For more information, see the topics Urine Test and Urine Culture.
• An ultrasound, cystoscopy, intravenous pyelogram, or voiding cystourethrogram, if birth defects within the urinary system are suspected. Daytime wetting may be related to problems in the development of the urinary system.
• A urodynamic study, if a lack of nervous system control of the bladder is suspected.

Treatment

If a child has both daytime and nighttime accidental wetting, the doctor may treat daytime wetting first, because children normally gain daytime control over their bladders sooner than nighttime control. Accidental daytime or nighttime wetting may increase after treatment is stopped.

If daytime wetting is caused by a medical condition, you can have treatment for the medical problem and the daytime wetting will stop.

Treatment for daytime wetting that is not caused by another medical condition may include:

• Medicine. Oxybutynin (such as Ditropan or Oxytrol) may be used to treat daytime wetting in children and adults. It helps control the bladder muscle that releases urine.
• Surgery. If the child has daytime wetting that is caused by birth defects within the urinary system, surgery to correct the defect may be needed. But sometimes the surgery does not make the accidental wetting stop.
• Counseling. Sessions with a counselor may be helpful for the child who has accidental wetting that is caused by emotional stress. Counseling may involve psychotherapy or hypnosis (hypnotherapy). The goal is to reduce or help manage the stress or to prevent stress.

Home treatment

Home treatment may be all that is needed to improve daytime accidental wetting, especially if the wetting is not due to any medical condition or stress. Try the following:

• Encourage your child to go to the bathroom whenever the urge happens.
• Reward your child for being dry. You may use hugs, stickers, or special treats as rewards.
• Don't make your child wear a diaper. Wearing a diaper may make him or her feel babyish. Also, it may be hard for a child to get the diaper off when using the toilet. Wearing disposable underwear, such as Pull-Ups, may be helpful. But it may also make the problem last longer, because the child may have less motivation to learn bladder control.

If your child delays going to the bathroom and holds on to urine until he or she loses control and wets, try the following:

• Encourage your child to use the toilet when you notice signs that he or she may need to go, such as squatting, squirming, crossing the legs, or standing very still.
• Offer more liquids to drink. Drinking more liquids will increase the amount of urine in the bladder, causing your child to need to go to the bathroom more often.
• Have your child go to the bathroom every hour during the day.
• Encourage your child to take extra time on the toilet so that he or she will be more likely to empty the bladder.