Diurnal Enuresis in Older Children: Daytime Urinary Incontence

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Diurnal enuresis in older children is defined as a daytime lack of bladder control. If the child is older than four and the diurnal enuresis is a new problem that occurs on most days, the child should be examined by a physician.

According to an NKUDIC article, “Incontinence happens less often after age 5: About 10 percent of 5-year-olds, 5 percent of 10-year-olds, and 1 percent of 18-year-olds experience episodes of incontinence. It is twice as common in boys as in girls.”

Diurnal enuresis may be classed in two categories: primary and secondary. The primary type is daytime wetting that occurs in a child older than would be expected to have the problem. The secondary type is defined as daytime wetting that occurs in a child previously successfully toiled trained and dry for at least three months prior.

Causes

The most common causes are related to abnormal elimination issues such as constipation. Other causes include infrequent voiding, structural problems, small bladder capacity, caffeinated food and drink, overly strenuous toilet training and events that cause the child anxiety or stress. Urinary tract infection can also be a cause of daytime wetting.

Diagnosis

A diagnosis is obtained once a full examination has been completed that includes patient history, urinalysis and physical exam. An ultrasonography exam of the bladder and kidneys may also be required.

Treatment

In most cases, diurnal enuresis in older children will correct itself as the child ages, bladder capacity increases, ADH production normalizes and the body signals of elimination need are more clearly functioning and recognized by the child. A NKUDIC article states that incontinence cases decrease by 15 percent for each year after the age of five.

Additional treatments may involve medication or training the bladder with exercises designed to coordinate the urethra and bladder.

Other strategies that may be used to help eliminate daytime wetting incidences include controlling fluid intake, avoiding caffeine and setting a urination schedule such as once every two hours.

Sources

Urinary Incontinence in Children. National Kidney and Urologic Diseases Clearinghouse (NKUDIC). Reviewed by Stuart B Bauer, MD. October 2006.

Diurnal Enuresis. Pediatrics in Review. Lane M. Robson, MD. 1997.