Urinary and Genital Disorders (Children)

Urinary incontinence

03/16/1999

Question:

My five and a half year old daughter has urinary incontinence. She says she doesn't feel the urge to void until some has come out and her underwear is usually wet at all times during the day. At night she is usually dry. Her urine also has a strong oder. I have taken her to our pediatrition and to a pediatric urologist. They ran an ultra sound of her bladder and kidneys, the also ran dye up to her kidneys to see if there was any abnomalities and none were found. The specialist said he thought she was allergic to caffeine, we took her off caffeine for 2 months and no change. I don't feel comfortable going back to this specialist since it took him 6 weeks of calling to have him get back to us after we informed him we are still having problems. We have even had the school psychologist test her to see if she could find any developmental problems that might be causing this. We really want to help our daughter but are unsure where we go from here?

Answer:

This type of urinary incontinence is relatively common and is usually not associated with any anatomical abnormalities. The normal x-rays furthermore suggest that she is structurally normal. The fact that a child doesn't feel the urge usually means one of two things. Most commonly it is because the child is holding their urine for so long the bladder at some point needs to empty to relieve the pressure. Children, understandably, have more important things to do with their lives than urinate and they will put this off as long as they can. The other possibility is that a child may have a bladder that is termed "unstable" whereby it will contract even before it is filled completely and on its own. Children with unstable bladders tend to have frequency also, needing to urinate every hour or so. Most children with daytime wetting will also have an element of constipation. Even though they may be defecating daily, they may not take the time to empty their bowels. Thus the first step in managing children with day wetting is to have them void every 2 hours even if they do not feel the urge to go. Every one has the ability to do this but it is often difficult to get a child to do this especially if he/she is a typical strong-willed 5 year old. Bran and fiber needs to be increased in the diet and efforts should be made to make sure the child is spending enough time on the toilet. If these simple measures are not effective then one may consider some medications to help control the bladder. Unfortunately, many 5 year olds do not care if they are wet or dry so this lack of motivation may make it harder to correct the behaviors that lead to wetting in the first place. Rewarding them for voiding when told may give them the motivation they need to be dry.

For more information:

Go to the Urinary and Genital Disorders (Children) health topic, where you can:

Read articles on this topic
Browse the previously asked questions
Ask your own question.

Response by:

Rama Jayanthi, MD
Pediatric Urologist
Section of Pediatric Urology
Nationwide Children's Hospital
The Ohio State University