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Primer: diagnosis and management of uncomplicated daytime wetting in children

Nature Clinical Practice Urology volume 3, pages 551–559 (2006)Cite this article

Abstract

Functional daytime wetting is a common source of pediatric urologic complaints. Evaluation typically begins in the office setting. In contrast to the adult population, where an inability to maintain voiding control is virtually always considered pathologic, the evaluation of urinary incontinence in children must occur within the context of the child's developmental age. Functional incontinence refers to cases of urinary incontinence in which no structural or neurologic abnormality can be identified. The underlying etiologic mechanisms are heterogeneous, and include disorders of both the storage and voiding phases of the bladder cycle. Optimal treatment of functional daytime wetting depends on an accurate determination of the underlying etiology. Therapeutic options include behavior modification, medication, and aggressive treatment of comorbid conditions such as urinary infection and constipation.

Key Points

  • Daytime wetting in the pediatric population must be evaluated in the context of the patient's developmental age

  • Functional daytime wetting in children is caused by diverse abnormalities in urine storage and voiding

  • It is important to identify and treat comorbid conditions such as urinary infection and constipation

  • Invasive urodynamic studies rarely have a role in the evaluation of functional daytime wetting

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Figure 1: Classification of childhood incontinence.
Figure 2: Evaluation of childhood wetting.
Figure 3: Ultrasound showing bladder-wall thickening in a 6-year-old female with recurrent urinary infections, vesicoureteral reflux, and daytime wetting.

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References

  1. Sillen U (2004) Bladder function in infants. Scand J Urol Nephrol Suppl 215: 69–74

    Article  Google Scholar 

  2. Goellner MH et al. (1981) Urination during the first three years of life. Nephron 28: 174–178

    Article  CAS  Google Scholar 

  3. Brazelton TB et al. (1999) Instruction, timeliness, and medical influences affecting toilet training. Pediatrics 103: 1353–1358

    CAS  PubMed  Google Scholar 

  4. Bloom DA et al. (1993) Toilet habits and continence in children: an opportunity sampling in search of normal parameters. J Urol 149: 1087–1090

    Article  CAS  Google Scholar 

  5. Hellstrom AL et al. (1990) Micturition habits and incontinence in 7-year-old Swedish school entrants. Eur J Pediatr 149: 434–437

    Article  CAS  Google Scholar 

  6. Norgaard JP et al. (1998) Standardization and definitions in lower urinary tract dysfunction in children. International Children's Continence Society. Br J Urol 81 (Suppl 3): 1–16

    Article  Google Scholar 

  7. Nevéus et al. (2006) The standardization of terminology of lower urinary tract function in children and adolescents: report from the Standardisation Committee of the International Children's Continence Society. J Urol 176: 314–324

    Article  Google Scholar 

  8. Hoebeke P et al. (1999) Assessment of lower urinary tract dysfunction in children with non-neuropathic bladder sphincter dysfunction. Eur Urol 35: 57–69

    Article  CAS  Google Scholar 

  9. Deluca FG et al. (1962) The dysfunctional 'lazy' bladder syndrome in children. Arch Dis Child 37: 117–121

    Article  CAS  Google Scholar 

  10. Hinman F Jr (1986) Nonneurogenic neurogenic bladder (the Hinman syndrome)—15 years later. J Urol 136: 769–777

    Article  Google Scholar 

  11. Scharf MB et al. (1987) Childhood enuresis. A comprehensive treatment program. Psychiatr Clin North Am 10: 655–666

    Article  CAS  Google Scholar 

  12. Loening-Baucke V (1997) Urinary incontinence and urinary tract infection and their resolution with treatment of chronic constipation of childhood. Pediatrics 100: 228–232

    Article  CAS  Google Scholar 

  13. O'Regan S et al. (1986) Constipation a commonly unrecognized cause of enuresis. Am J Dis Child 140: 260–261

    CAS  PubMed  Google Scholar 

  14. Kaneti J et al. (1984) Case profile: urinary retention due to fecal impaction in a child. Urology 23: 307

    Article  CAS  Google Scholar 

  15. O'Regan S et al. (1985) Constipation, bladder instability, urinary tract infection syndrome. Clin Nephrol 23: 152–154

    CAS  PubMed  Google Scholar 

  16. van Gool JD et al. (1984) Bladder–sphincter dysfunction, urinary infection and vesico-ureteral reflux with special reference to cognitive bladder training. Contrib Nephrol 39: 190–210

    Article  CAS  Google Scholar 

  17. Smellie JM et al. (1988) Prophylactic co-trimoxazole and trimethoprim in the management of urinary tract infection in children. Pediatr Nephrol 2: 12–17

    Article  CAS  Google Scholar 

  18. van Gool JD et al. (1992) Historical clues to the complex of dysfunctional voiding, urinary tract infection and vesicoureteral reflux. The International Reflux Study in Children. J Urol 148: 1699–1702

    Article  CAS  Google Scholar 

  19. Bauer SB (2002) Special considerations of the overactive bladder in children. Urology 60: 43–49

    Article  Google Scholar 

  20. Wehby MC et al. (2004) Occult tight filum terminale syndrome: results of surgical untethering. Pediatr Neurosurg 40: 51–58

    Article  Google Scholar 

  21. Wan J et al. (1993) Stress leak point pressure: a diagnostic tool for incontinent children. J Urol 150: 700–702

    Article  CAS  Google Scholar 

  22. Saedi NA et al. (2003) Natural history of voiding dysfunction. Pediatr Nephrol 18: 894–897

    Article  Google Scholar 

  23. Hellstrom AL et al. (1987) Rehabilitation of the dysfunctional bladder in children: method and 3-year followup. J Urol 138: 847–849

    Article  CAS  Google Scholar 

  24. Wiener JS et al. (2000) Long-term efficacy of simple behavioral therapy for daytime wetting in children. J Urol 164: 786–790

    Article  CAS  Google Scholar 

  25. Pohl HG et al. (2002) The outcome of voiding dysfunction managed with clean intermittent catheterization in neurologically and anatomically normal children. BJU Int 89: 923–937

    Article  CAS  Google Scholar 

  26. Allen TD (2003) Forty years experience with voiding dysfunction. BJU Int 92 (Suppl 1): 15–22

    Article  Google Scholar 

  27. Curran MJ et al. (2000) The overactive bladder in childhood: long-term results with conservative management. J Urol 163: 574–547

    Article  CAS  Google Scholar 

  28. Nijman RJ (2004) Role of antimuscarinics in the treatment of nonneurogenic daytime urinary incontinence in children. Urology 63: 45–50

    Article  Google Scholar 

  29. Jonville AP et al. (1993) Adverse effects of oxybutynin chloride (Ditropan) in pediatrics [French]. Arch Fr Pediatr 50: 27–29

    CAS  PubMed  Google Scholar 

  30. Hjalmas K et al. (1992) Functional daytime incontinence: pharmacological treatment. Scand J Urol Nephrol Suppl 141: 108–116

    CAS  PubMed  Google Scholar 

  31. Meadow SR (1990) Day wetting. Pediatr Nephrol 4: 178–184

    Article  CAS  Google Scholar 

  32. Sundin T et al. (1973) The sympathetic innervation of the urinary bladder and urethra in the normal state and after parasympathetic denervation at the spinal root level. An experimental study in cats. Scand J Urol Nephrol 7: 131–149

    Article  CAS  Google Scholar 

  33. Austin PF et al. (1999) α-Adrenergic blockade in children with neuropathic and nonneuropathic voiding dysfunction. J Urol 162: 1064–1067

    Article  CAS  Google Scholar 

  34. Rushton HG (1993) Older pharmacologic therapy for nocturnal enuresis. Clin Pediatr (Phila) 10–13

  35. Fouron JC et al. (1971) ECG changes in fatal imipramine (Tofranil) intoxication. Pediatrics 48: 777–781

    CAS  PubMed  Google Scholar 

  36. Sureshkumar P et al. (2003) Treatment of daytime urinary incontinence in children: a systematic review of randomized controlled trials. J Urol 170: 196–200

    Article  CAS  Google Scholar 

  37. Sugar EC et al. (1982) Urodynamic biofeedback: a new therapeutic approach for childhood incontinence/infection (vesical voluntary sphincter dyssynergia). J Urol 128: 1253–1258

    Article  CAS  Google Scholar 

  38. McKenna PH et al. (1999) Pelvic floor muscle retraining for pediatric voiding dysfunction using interactive computer games. J Urol 162: 1056–1063

    Article  CAS  Google Scholar 

  39. Porena M et al. (2000) Biofeedback successfully cures detrusor–sphincter dyssynergia in pediatric patients. J Urol 163: 1927–1931

    Article  CAS  Google Scholar 

  40. Chin-Peuckert L et al. (2001) A modified biofeedback program for children with detrusor–sphincter dyssynergia: 5-year experience. J Urol 166: 1470–1475

    Article  CAS  Google Scholar 

  41. Herndon CD et al. (2001) Interactive computer games for treatment of pelvic floor dysfunction. J Urol 166: 1893–1898

    Article  CAS  Google Scholar 

  42. Erickson BA et al. (2003) Polyethylene glycol 3350 for constipation in children with dysfunctional elimination. J Urol 170: 1518–1520

    Article  CAS  Google Scholar 

  43. Hein HA et al. (1978) Who should accept primary responsibility for the encopretic child? A successful pediatric program based on dietary control, bowel training, and family counseling. Clin Pediatr (Phila) 17: 67–70

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Fellow in pediatric urology based at the University of Washington, Seattle, WA

    Vijaya M Vemulakonda

  2. Assistant Professor and a specialist in pediatric urology at the Texas Children's Hospital and the Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA

    Eric A Jones

Authors
  1. Vijaya M Vemulakonda
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  2. Eric A Jones
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Correspondence to Eric A Jones.

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The authors declare no competing financial interests.

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Vemulakonda, V., Jones, E. Primer: diagnosis and management of uncomplicated daytime wetting in children. Nat Rev Urol 3, 551–559 (2006). https://doi.org/10.1038/ncpuro0584

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