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Tuesday, May 21, 2013
Urinary and Genital Disorders (Children)
What could cause urinary `leaking`?
My 10 year old daughter has no health problems, no bedwetting history, no toilet training problems, etc. She has lately been complaining, and is very upset, that when she thinks she is finished urinating, and puts her underpants on, she then `leaks` more urine. SHe waits until she thinks she is done, wipes herself well, etc. She was crying about it tonight, although it seems it is more uncomfortable and embarassing than hurtful or painful. Any suggestions as to what might be going on?
Urinary leakage can start at any time in indivduals. Leakage that occurs after voiding can be due to many causes. Firstly, a child may have urine that goes into the vagina. Then upon arising the urine may leak out into the underpants. This is called vaginal reflux and can be managed by having the child spread her legs widely during voiding to spread the outer labia apart and allow for all the urine to pass into the toilet. Alternatively, a parent can teach the child to manually hold the labia apart while voiding. Another trick is to have her sit backward on the toilet and see if that solves the problem. Another cause of leakage may be an overactive bladder. This is quite common in children and usually manifests by a child having some degree of frequency and/or urgency. The development of bladder overactivity may be related to constipation of fecal retention, i.e. not emptying the bowels completely. Bladder overactivity may be treated by a course of medicinces. A careful history is usually all that is required to sort out the cause of the wetting, but occasionally bladder studies called urodynamics, which require a catheter in the bladder, may be necessary. An ultrasound of the kidneys and the bladder is useful in assuring that there are no structural abnormalities of the urinary tract. This, however, is quite unlikely with the type of wetting that you are describing.
Rama Jayanthi, MD
Clinical Assistant Professor of Urology
College of Medicine
The Ohio State University