Daytime wetting and frequent urination

When is it considered a problem?

Most children learn to stay dry during the day between 2 and 4 years of age. After age 5, regular daytime wetting, urinating too often or too rarely, and sudden urgent need to use the toilet are called lower urinary tract dysfunction and need evaluation.

This affects about 5–10% of school-age children and often occurs together with constipation, urinary tract infections and bedwetting.

Main types

• Overactive bladder. The bladder contracts suddenly before it is full. The child suddenly runs to the toilet and sometimes doesn’t make it. To hold urine, the child crosses the legs, sits on a heel or squeezes the genitals.
• Voiding postponement. The child gets absorbed in play or a screen and waits until the last moment.
• Dysfunctional voiding. The pelvic floor muscles do not relax during urination, the urine stream is interrupted, and the bladder does not empty completely.
• Underactive bladder. The child urinates rarely and strains to empty.

Rarer causes: in girls, an ectopic ureter (constant dribbling); in boys, posterior urethral valves; nervous system problems; giggle incontinence (wetting when laughing).

Evaluation

• a detailed conversation and a bladder diary (printable form),
• physical examination, especially of the lower back,
• urine test,
• uroflowmetry and ultrasound measurement of the urine left after voiding,
• kidney and bladder ultrasound when needed.

Most children do not need invasive tests.

Treatment

Urotherapy

The foundation of treatment is urotherapy, which means teaching good toilet and lifestyle habits:

• regular toilet visits every 2–3 hours, 5–7 times a day, even without the urge,
• sitting comfortably on the toilet: feet supported, knees slightly raised, without rushing,
• enough water spread evenly through the day, avoiding sugary and fizzy drinks,
• treating constipation, because a full bowel presses on the bladder,
• the child’s motivation: a calendar, marking dry days, praise.

Additional treatments

• Medicines: for overactive bladder, medicines that relax the bladder (oxybutynin, solifenacin).
• Biofeedback: in dysfunctional voiding, the child learns to relax the pelvic floor muscles through a game on a screen.
• Nerve stimulation: in some cases, electrical stimulation through the skin.

If a child with daytime symptoms also has bedwetting, the daytime problems are treated first.