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Day wetting
1Department of Paediatrics and Child Health, St. James's University Hospital, Leeds, UK.
Insights
Daytime wetting in children over five is often linked to unstable bladders and urinary tract infections, particularly in girls. Management focuses on behavioral therapies and complete bladder emptying, with drugs showing limited efficacy.
Area of Science:
- Pediatric Urology
- Child Psychology
Background:
- Daytime wetting affects approximately 1% of healthy children over age 5.
- Urge incontinence is the primary cause, more prevalent in girls, and often associated with bacteriuria.
- A link exists between daytime wetting, infection, and potential upper tract damage.
Purpose of the Study:
- To explore the causes and associations of daytime wetting in children.
- To evaluate the effectiveness of various management strategies.
- To understand the relationship between daytime wetting, infection, and renal health.
Main Methods:
- Literature review and analysis of clinical observations.
- Assessment of associations between daytime wetting, bacteriuria, and bladder instability.
- Evaluation of treatment outcomes for behavioral therapies versus pharmacological interventions.
Main Results:
- Most children with daytime wetting exhibit unstable bladders and may adopt 'holding' postures.
- Bacteriuria is common (50% prevalence) in girls with daytime wetting.
- 10-15% of children achieve dryness within a year, accelerated by bacteriuria eradication and behavioral management.
Conclusions:
- Daytime wetting management should prioritize behavioral approaches, encouraging frequent and complete voiding.
- Eradication of bacteriuria and supportive management significantly improve outcomes.
- Complex behavioral training and biofeedback are beneficial for severe cases; drug efficacy is not well-supported.
Abstract:
About 1% of healthy children over the age of 5 years have troublesome daytime wetting. Two-thirds of those who wet by day are reliably dry at night. The problem is more common in girls and is usually the result of urge incontinence. Although the wetting may be exacerbated by giggling and/or stress, pure giggle micturition and isolated stress incontinence are both rare. There is a strong association with bacteriuria (50% prevalence) in girls who wet by day. A potentially important relationship exists between day wetting, infection, reflux and upper tract damage, which is expressed in an extreme form in the syndromes of incoordinated voiding and progressive renal damage. Most children who wet by day have unstable bladders. Many of them adopt characteristic "holding" postures. There is an increased incidence of emotional disorder compared with children who merely wet the bed. Between 10% and 15% of children who wet by day become dry during the next 12 months. The acquisition of dryness is accelerated by eradication of bacteriuria and a sympathetic and energetic management regime, which should place responsibility on the child and result in the child voiding more frequently and completely. Reminder alarms and other behaviour therapies have proved effective. There is no satisfactory evidence for the efficacy of drugs. More complex behavioural training regimes including biofeedback are valuable for severe cases.