Download ENURESIS Daytime - Dayton Children`s Hospital

DAYTIME ENURESIS
Daytime Enuresis (Urine Accidents)
This form explains about Daytime Enuresis and what to expect if your child comes to Dayton Children’s,
Nephrology Department for evaluation and / or treatment.
What is Enuresis?
Enuresis is the medical name for accidental urination in children who should be developmentally able to control
their bladders. Girls usually have bladder control before boys. Daytime urine control generally occurs before
nighttime control is achieved.
There are different types of wetting that may occur:
•
Diurnal Enuresis: daytime urine accidents.
•
Nocturnal Enuresis: nighttime bedwetting.
•
Primary Enuresis: When the child has never been dry since potty training.
•
Secondary Enuresis: When the child had a period of dryness (of at least 6 months), but then wetting
problems develop.
What causes Daytime Enuresis?
Enuresis may be caused by many factors. The bladder is made of layers of muscle that expand (relax) and shrink
(contract) as urine enters or leaves the bladder. Normally during urination the bladder contracts as the sphincter
(muscular ring closing the base of the bladder, urethra or bladder outlet) is relaxed allowing urine to leave the
bladder. The bladder may be of normal size. However, it is not able to hold a normal amount of urine because of
muscle spasms (expontaneous, uninhibited contractions). When the bladder becomes overactive, or irritable, it is
more difficult to keep the sphincter closed and leaking may result.
Leaking may occur for many reasons, one of the most common is a condition called dysfunctional voiding. Many
children go long periods of time without urinating (voiding) during the day. Infrequent voiding is common in
children. There are many reasons for this: hesitation to use school or public toilets or unwillingness to interrupt
playtime. Infrequent voiders, learn to turn off a bladder that is sending signals to empty when full, by misusing their
“off switch” or tightening the sphincter. Many children who are infrequent voiders have virtually no sensation of
bladder fullness despite large volumes of urine (enlarged bladder). This loss of sensation develops slowly over
time as the child becomes accustomed to holding urine and ignoring the urge to void. A typical maneuver to
accomplish this is squatting with the heels on the perineum (private area) or rocking on the edge of a chair. Some
children will cross their legs or do the “pee-pee” dance.
In addition, children are often in a hurry to get out of the bathroom and do not take the time to empty their bladder
completely. Many children do not drink enough fluids during the day. Concentrated urine may also add to bladder
irritability producing more contractions.
Other causes of daytime enuresis may include urinary tract infections, abnormalities of the urinary tract or problems
with nerve control of the bladder.
Treatment for daytime enuresis:
Timed voiding plan: Your child should go to the bathroom to urinate at least every 2 to 3 hours throughout
the day. If your child is not able to void every 2 to 3 hours he/she is not drinking enough.
Children should be taught to take their time and relax when emptying their bladders. It is not normal to
need to strain (or push) in order to urinate.
DAYTIME ENURESIS
The Children’s Medical Center
Nephrology Department
Phone:
937-641-3304
Fax:
937-641-5091
Page
Abiodun Omoloja, M.D.
Pediatric Nephrology
Leonardo M. Canessa, M.D.
Medical Director
One Children’s Plaza, Dayton, Ohio 45404
e-mail: [email protected]
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DAYTIME ENURESIS
It is important to flush out the bladder and kidneys with a good fluid intake
every day. Urine should be light yellow or clear in color, not dark yellow or amber.
Your child should drink ___________oz of caffeine-free fluids daily. Milk should be limited to __________servings
daily.
Proper hygiene is very important. Girls should be taught to wipe from front to back and sit on the toilet with
their legs wide open. They should wear cotton underpants; cotton dries easily and allows air passage. Bathing
suits should be taken off when finished swimming. They should not be worn as clothing or underneath clothing.
Showers are the best choice for daily hygiene. Sitting in a bathtub with bath bubbles, oils, shampoo or
even soap can be irritating.
Complete bladder emptying at least twice a day. This is called double voiding. Sit your child on the toilet to
urinate. After they are finished, wait for a short time (have them sing the ABC’ or a short song) then try to urinate
again, should be done while relaxing; avoid straining. This will help to ensure complete emptying of the bladder.
Your child should have a daily bowel movement. Many times constipation and urine accidents are related.
In order to have a healthy urinary tract, bowel problems must be resolved.
If there is no improvement with conservative measures treatment with medication may be considered. The
most common medication prescribed is oxybutinin (Ditropan). Oxybutinin helps to relax the smooth muscle of the
bladder and decrease irregular and expontaneous bladder contractions. Possible side effects include flushed
cheeks, dry mouth and constipation. These side effects do not occur in all children. Other medications are aimed
to relax the sphincter (muscular ring closing the urethra or bladder outlet); your doctor should discuss those with
you.
Unfortunately, there is not a quick “cure” for dysfunctional voiding and enuresis. Your child must re-learn new
habits and this can be a long, slow process. Progress generally occurs slowly, a little at a time. Your child does not
wet on purpose. It is important to be patient. Following through with recommendations and follow-up is important.
Working together, parents and your child with clinic guidance, we can make a difference!
You can seek more information from our Family Resource Center located on the 2nd floor of the Taggart Pavilion or
from the following web sites:
http://www.nlm.nih.gov/medlineplus
http://www.niddk.nih.gov/
TB 06/05
DAYTIME ENURESIS
The Children’s Medical Center
Nephrology Department
Phone:
937-641-3304
Fax:
937-641-5091
Page
Abiodun Omoloja, M.D.
Pediatric Nephrology
Leonardo M. Canessa, M.D.
Medical Director
One Children’s Plaza, Dayton, Ohio 45404
e-mail: [email protected]
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