Daytime accidental wetting (diurnal enuresis)

Daytime accidental wetting is much less common than bed-wetting. However, over half of children who wet during the day also wet the bed at night.

Knowing the cause of the wetting will help you and your child's health professional 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 underlying condition will usually stop the wetting. However, 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 once 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 using the bathroom.

Some children have accidental daytime wetting because they try to hold their urine too long. To keep from wetting, 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 health professional is important if there is any chance a medical condition is the cause.

Call your health professional if:

• Your child has signs of a bladder or kidney infection or other symptoms, such as back pain, pain in the belly (abdominal pain), or fever. Signs of a bladder or kidney infection include:
  • 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.

Evaluating daytime accidental wetting

If you take your child to a health professional for help with the child's accidental wetting, a medical history and physical examination will be done to discover if the wetting is a symptom of a medical condition. The health professional will ask the parent and child questions about the wetting, such as when and how often it happens. As part of the physical exam, the health professional 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. See the topics Urine Test and Urine Culture.
• Psychological testing if emotional stress is suspected.
• Special tests, if birth defects within the urinary system are suspected. Daytime wetting may be related to problems in the development of the urinary system. An ultrasound, cystoscopy, intravenous pyelogram, or voiding cystourethrogram may be done.
• 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, treatment for daytime wetting is started first because this follows the normal development of children. Accidental daytime or nighttime wetting may increase after treatment is stopped.

If daytime wetting is caused by a medical condition, the medical condition will be treated, and usually the daytime wetting will stop.

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

• Medication. Oxybutynin chloride (Ditropan) may be used to treat daytime wetting in children over age 5 and adults. It helps control the bladder muscle that releases urine. See the Medication section of this topic for more information.
• 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. However, sometimes the surgery does not make the accidental wetting stop.
• Counseling. Sessions with a counselor may be helpful for the child with 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 from developing.

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.
• Teach your child special exercises to control the bladder muscle that releases urine. See exercises to help a child gain bladder control and bladder-stretching exercises.
• 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 like 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 about every 1½ hours 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.