Make Daytime Wetting a Thing of the Past
Did you know that many children who are potty-trained can experience pee accidents during the day? Sometimes these accidents entail little wet spots in the underwear, but sometimes kids have full-on accidents that require a change of clothes. This can be a very frustrating problem for both kids and their parents. As a nurse practitioner in the Division of Pediatric Urology at Children’s Hospital Los Angeles, I work with boys and girls of all ages who suffer from daytime wetting, which is also called diurnal enuresis. By writing this RN Remedies® blog post, I hope to provide some helpful suggestions to keep your child high and dry. make things a bit better (and dryer)!
Reasons Behind Daytime Wetting
Diurnal enuresis is when a child who should be potty-trained has wetting accidents during the day. Statistics say this happens in about 3 to 4 percent of children, particularly school-aged girls, and we see a lot of cases of this at Children’s Hospital Los Angeles. Daytime wetting is generally:
- Involuntary, meaning your child did not do it on purpose.
- May be a result of bad toileting habits and behaviors that have been going on since potty training.
- May have been developed after potty training and over time.
One common scenario we deal with in the urology clinic is when kids hold their pee for so long that they leak or dribble urine. I often hear from parents that their children don’t want to stop playing (despite crossing their legs, sitting on their heels or doing the “peepee dance”) to go use the bathroom. Other children refuse to use the toilet at school because perhaps the bathroom is “gross” or the teacher doesn’t permit bathroom trips during class time. I have also seen kids who start holding their pee after their first urinary tract infection (UTI) because it caused pain and they subsequently hold their urine out of fear that it will hurt to pee.
Diurnal enuresis can also be secondary to more complex issues such as an active UTI, a problem with your child’s urinary tract or nervous system. Although they are less common than behavioral issues, it is important to rule out all possibilities first. It’s recommended to consult with your child’s pediatrician.
Overcome Bad Toileting Habits
As I mentioned earlier, pee accidents are usually caused by bad toileting habits. If your child has been wetting their underwear during the day for a while, it will take time to undo these habits. The key is to be patient, encouraging and persistent. These tips will help:
- Make sure your child stays on a “timed potty schedule.”
- Encourage your child to pee at least every two to three hours during the day, even if her or she doesn’t feel the urge to go.
- Try purchasing a beeping or vibrating “potty watch” to help keep your child on track. You can find them online.
- Use a star chart to track trips to the bathroom. Your child should pee when they wake up, in mid-morning, at lunchtime, in mid-afternoon, around dinner time and again before bed. Children can earn “bonus stars” for staying dry. From my experience, kids are very motivated by incentives like earning stars stickers redeemable for a prize.
The Role of “Number Two”
Kids that hold their pee usually hold their poop as well. Constipation can play a significant role in causing pee accidents. Did you know that your child could be constipated even if they do have some sort of a bowel movement every day? Sometimes we find that children who don’t seem constipated are actually “full of poop” when an X-ray is performed.
When your child’s colon is full, it can prevent your child from sensing signals required to let them know they need to use the bathroom. A colon full of poop can put pressure on the bladder, which can lead to pee accidents. Talk to your child’s pediatrician if you think your child could be constipated. Pee accidents can be improved significantly just by fixing constipation.
Not Emptying the Entire Bladder
If your child is good at holding their pee, it can be difficult for them to relax their external sphincter (bladder muscle that loosens and tightens to control urination) so they don’t empty their bladder completely when they go to the bathroom. They also may relax their external sphincter at inappropriate times and leak pee. This common phenomenon is something called “voiding dysfunction.” When the bladder doesn’t get emptied completely, it can cause your child to feel like they need to go to the bathroom a few seconds after they just went! Sound familiar? Your child may leak right after they went to the bathroom because they didn’t empty their bladder all the way. Other times when kids rush through voiding, they will just pee “enough” to make that urge to away but their bladder is still full of pee. Did you know that when kids don’t empty their bladder completely, the stagnant pee increases their risk of developing a urinary tract infection?
A good way to help your child is to have them “double void.” This means that after they finish peeing, have them try again to see if any more pee will come out. I tell my patients to go pee, then jump up and down a few times or do a little dance, and then try to pee again. My other helpful tips:
- Encourage your child not to rush through peeing. You may want to use a timer in the bathroom to make sure he or she is spending enough time to pee and poop effectively.
- Encourage your child to relax and breathe deep when on the potty, to help relax his or her muscles and improve bladder emptying.
- Place a foot stool in front of the toilet if your child’s legs are short and don’t reach the floor. This will allow him or her to rest the feet and have an easier time relaxing.
Girls who sit on the toilet with their thighs mushed together can leak pee in their underwear after they go to the restroom because of “vaginal voiding.” This is when urine backflows up the vagina, which is right next to the urethra, when the legs are not spread wide. What goes up must come down, so when these girls start walking the urine will dribble down, from their vagina into their underwear. If you have a daughter, these recommendations help:
- Make sure she sits with her legs spread wide on the toilet so the thighs are not touching. It may be helpful to have her straddle the toilet backward.
- Encourage your daughter to pat her private parts with toilet paper, especially if she is overweight. It may be helpful to show her how to gently spread her outer labia majora (the bigger lips in the private area) to dab away any urine that may be pooling inside them.
I hope this article takes some of the stress out of daytime pee accidents and helps lead to dry undies for your child. While you’re implementing these tips at home, be patient and reward children for their hard work! If you can get children to work for something they want, like a trip to an amusement park, a new hula-hoop, a video game or watching “Frozen” for the seventieth time, then they may be more motivated to make changes and stick with them. Good luck and please share this with your friends and family who are parents of young children.