Enuresis – Daytime wetting
What is enuresis?
Enuresis is the involuntary discharge of urine. It is considered to be a problem after the age of five by which time it is generally accepted that bladder control should have been established.
Children with daytime wetting characteristically feel the urge at the last minute and may suddenly demonstrate holding postures e.g. ‘curtsey’ using their heel to stop the flow of urine.
Around 3-4% of children between the ages of 4 and 12 years present with daytime wetting. Daytime wetting is twice as common in girls. (Lane and Robertson, 1997). Two thirds of these have combined day and night time wetting. It is important to address the daytime wetting first.
First Steps
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Keep a diary of fluid intake and volume of urine output for a few days using the chart in this document.
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Take the child to the doctor to be assessed and rule out any urinary tract infection. Make sure to mention any pain on passing urine, poor urinary stream or continuous dribbling of urine. Constipation can also adversely affect bladder function and it is important to rule this out.
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Contact your local continence advisor. See the “Continence Service Providers” section of the NZCA website www.continence.org.nz to find an advisor in your area.
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If your child is school aged contact the Public Health Nurse affiliated with the school for support.
Management
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Ensure the child drinks well during the day. The recommendation for children is 6-8 glasses of water or water based cordial evenly spaced throughout the day (including 3-4 glasses while at school).
DRINKING LESS DOES NOT HELP as the bladder fills more slowly making it harder for the child to recognise a full bladder, reducing bladder capacity and causing the urine to be more concentrated, irritating the bladder wall.
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Once the child is drinking more, encourage the child to pass urine at regular intervals (2.5 – 3 hourly) throughout the day. ‘Time Toileting’ or bladder retraining may be helpful to support this.
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If the child is at school it is important to communicate with the child’s teacher about management during school hours.
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If using rewards/incentives these need to be for something the child has control over e.g. drinking well, using the toilet. Reward them for sitting on the toilet regardless of the result as they will not be able to achieve dry pants initially.
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Encourage them to take time to empty the bladder. Children whose legs don’t reach the floor will be able to relax the pelvic floor more effectively if they have a low stool for their feet. Ideally boys should stand on a low stool (if needed), make sure their pants are down properly and point the penis downwards into the toilet.
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Double voiding can be useful. The child counts to 10 or 20 and tries to empty their bladder again.
Management
A urine test and ultrasound are usually the only investigations most children will need.
Urinary tract infections can cause frequency (going to the toilet a lot), and urgency (needing to go urgently). Any child who has a urine infection should be seen by a doctor.
Antibiotics are used to treat urinary tract infections and can reduce related bladder instability.
Bladder Retraining
Retraining to expand bladder capacity is a technique used once continence is achieved. This involves the child holding on for a set number of minutes after feeling the urge to go.
Time Toileting
Time toileting is a symptom-relief technique used to manage wetting while other components of the management plan are put in place.
Fluid Balance Chart
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DATE |
FLUID IN (MLS) |
WEES OUT (MLS) |
COMMENTS |
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TOTALS |
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References:
Lane, M and Robertson, MD “Diurnal Enuresis” Paediatrics in Review Vol 18(12) Dec 1997
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