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Daytime enruesis


Hi, My daughter is 9 and still wets during the day. We have done everything medically, she has seen a urologist and pediatrician. She is currently waiting on a bed wetting alarm but if we can't get the days dry there is not much point starting the nights. I am worried about her mental health with being wet at school and wearing pull ups while at school camps / sleepovers etc is very embarrassing for her. She has a public health nurse visit her every week at school. Bascially we are a our wits end with where to go next. Any suggestions??


It is not uncommon for children to wet during the day, but at your daughters age it would be starting to get embarrassing for her.
When is the wetting occurring?  If it is when she is laughing or giggling, it is likely to be "giggle incontinence.  Teach her how to strengthen her pelvic floor muscles. Squeezing up the muscles around her bottom like she is trying not to pass wind, and count to five Before relaxing the muscles. This will strengthen those muscles so can she can squeeze them up and prevent urine leaking out.  It can take some weeks before this happens though.
If it occurs when she is engrossed in activities, put her on a regular toileting timetable to ensure her bladder empties more frequently and the chance of leaking is reduced.
If she has very little warning of needing to go to the toilet, passes low volumes, and needs to toilet frequently, she may have overactive bladder.  Get her to drink regularly throughout the day, a fUll cup or glass of fluid every two hours. Get her to to the toilet at the same time approximately too.  This helps her exercise her bladder right through the day so it gets stronger and less likely to leak.  Get her to measure her urine weekly, not when busting, just with a normal urge to go.  For an average sized 9year old I think she should be passenger around 270 - 300mls.  If the measures do not start to increase and the urgency is still a problem, a short course of an anticholinergic from her GP will help calm her bladder down.  Once her measures have reached her goal she can slowly reduce the amount of anticholinergic until she doesnt need it anymore.
Bedwetting alarms have a good success rate, but I think she needs to get her bladder up to stood size before she starts on one.  
I hope these suggestions are helpful to you.