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Urinary and Genital Disorders (Children)

4 year-old girl leaking urine

06/18/2008

Question:

I have an almost 4 year-old who is toilet trained day and night. But quite often, she is complaing of "dripping" into her knickers, sometimes only one drop and sometimes I can`t see anything. She insists on wearing a nappy. She is very distressed about the whole thing and is wearing us down. We just give up and let her wear a nappy, which is not great at kindy. We have had her tested for urine infections and Thrush and both have come back negative. What else could it be?

Answer:

She may have an overactive bladder or vaginal voiding. Both are relatively common in 4 year-old girls. With an overactive bladder, often girls state that they leak urine (typically small amounts), without any sensation of needing to urinate. At times, they result from a urinary tract infection.

With vaginal voiding, typically girls leak a small amount of urine after voiding. The former problem generally is managed pretty well with timed voiding every 1 1/2 to 2 hours, and occasionally medication is necessary. With vaginal voiding, wide separation of the thighs (and even voiding backwards on the toilet seat) is effective. If these measure do not work, then evaluation by a pediatric urologist would be helpful.

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Response by:

Jack S Elder, MD, FACS, FAAP Jack S Elder, MD, FACS, FAAP
Clinical Professor of Urology
School of Medicine
Case Western Reserve University