Daytime Wetting or Voiding Dysfunction
Explanation of common symptoms/ problems
Bladder symptoms in children or teenagers may be as a result of underlying medical conditions related to the kidneys or bladder or, more commonly, as a result of unintentional changes in how the bladder works. This might happen in response to previous pain, infection, constipation, or changes in your child’s day-to-day routine i.e. drinking habits, what they are eating, or stresses such as changing schools, new siblings etc.
Symptoms may include:
- Overactive bladder i.e. going more often; sudden urgency to go to the toilet; possibly not making it to the toilet in time and having wetting accidents; waking more often at night for the toilet.
- Voiding dysfunction i.e. sudden urgency to go to the toilet; wetting accidents which they may or may not feel happening; feeling that they don’t fully empty their bladder after a wee; possible occurrence of UTIs (urinary tract infections).
- Giggle incontinence i.e. wetting accidents if laughing e.g. laughing at a joke, being tickled or chased.
- Very infrequent urination, possibly only going for a wee two or three times in a day which can lead to wetting accidents, and often can result in some poo accidents or soiling in the underwear at times.
Self help / Advice
A child should drink enough fluids, ideally water, spread throughout the day. A good estimate of intake would be 30ml for every kg your child weighs. Perhaps have times/situations throughout the day that are reminders to have a cup of water or drink from their water bottle. Using a star chart or rewards system may help.
- Avoid giving your child / teen caffeinated drinks (tea, coffee, cola, energy drinks, hot chocolate, green tea), fizzy drinks or sugary juices, or drinks with artificial sweeteners (light, diet or zero drinks).
- Water is best, but some no-added-sugar cordial can add some flavour if needed, or occasional apple or grape juice would be better than citrus juices, especially if slightly watered down.
- Avoid large drinks within three hours of bedtime.
- Some people find reducing tomato-based products or sauces, curries, spicy foods and vinegar may also help.
- Pears, apricots, melon or mango as snacks may be better than more acidic fruits such as oranges.
- Go to the toilet to wee every 2 – 3 hours. Plan a routine or make a schedule for your child, perhaps in line with their school day e.g. morning, first break, lunchtime, after school, before dinner, getting ready for bed/before lights out. Children often get distracted and forget to go until the ‘last minute’. Tick charts or reward cards may help alongside a toilet schedule.
- Encourage your child to sit well on the toilet and use a footstool under their feet if possible. Take their time, breath into the tummy and do not force or strain to empty, try to just relax. Remind them to use this strategy at school or anywhere they may need to go. Try to remove any negativity about toilets outside of the home and talk about going regularly at school, at home or when visiting other people’s homes as a normal thing to do.
- For girls, make sure they know to wipe from front to back after a wee or a poo.
- If necessary speak with any teachers, sports coaches etc. to ensure the child is free to use the toilet when needed.
- Encourage them to be open about any wee or poo accidents or leaks and discuss what they are to do when this happens e.g. having a change of pants, carrying wet wipes. Try not to talk about it as bold, dirty or lazy and don’t punish the child. It is often useful to refer to these as ‘leaks’ rather than ‘accidents’.
- Constipation or difficulty with bowel movements can have a negative impact on bladder symptoms. Ask your child/teen about this and encourage them to tell you when they have a poo. Drinking enough water, a balanced diet with enough fibre, fruit and vegetables, as well as regular exercise can help. Click HERE for more information about bowel dysfunction in children and teenagers.
Where to go to next
It is important that your child or teenager is assessed to rule out any underlying medical causes that may require further tests or treatment. If bladder symptoms continue to be a problem you should discuss this with your GP, if you have not already, as they will have a lot of information to offer and be in a position to refer your child/teen for any follow-up that may be required. They may suggest medications, tests or they may refer your child/teen to see a specialist doctor (urologist).
You can also ask to be referred to a physiotherapist with specialist knowledge of pediatric pelvic health for assessment and management of bladder and bowel symptoms.
Find a Physiotherapist
You might find some more information through some of these sources:
What to expect from physiotherapy
The specialist pelvic health physiotherapist will ask in detail about the symptoms, and what treatments you may have tried already.
- They will explain what seems to be causing the problems and what strategies may now be useful.
- In order to have a more detailed examination of the bladder they will ask you to fill in a bladder diary with your child/teenager to look at what they are drinking, how often they go the toilet and how much urine is passed, usually over a three-day period. This will allow the physiotherapist to prescribe individualized bladder training strategies to help improve the symptoms.
- Often they will also ask for a record of bowel movements to assess any overlapping issues and may have some advice about having a regular, comfortable poo.
- They will probably ask about toilet habits, positions or routine and talk about how this fits in with the day at school, after-school activities, sports etc.
- If needed the physiotherapist may also have a look at your child/teenager’s tummy, if they are happy to be examined. Occasionally they might ask to have a look at the movement of the muscles around the bottom. This might help to teach your child how to ‘let go’ or empty properly, or perhaps learn how to hold on a little better depending on what they need to learn. An examination will only be done if necessary and with you, and your child’s, full consent.
- You will go home with advice, strategies to improve the symptoms, and maybe some exercises to do; and often will come back to see the physiotherapist with some charts showing how you all have been getting on.
- Further strategies such as breathing exercises, hands-on techniques, pelvic floor muscle retraining exercises, biofeedback, electrical stimulation or other exercises may be discussed on an individual basis depending on your child/teenager’s specific assessment.