Some common red flags may require further investigation, including:
The most common causes of daytime wetting include not voiding (passing urine) as soon as the bladder is full, bladder infection, and constipation. Often all three are present at the same time.
Not voiding as soon as the bladder is full is very common.
Lisa, a very particular six-year-old girl, keeps coming home from her new elementary school with damp panties. She tells her mom that the bathrooms are too dirty for her to pee in. She purposely does not drink any liquids at school so that she can avoid the bathroom. When she does feel the need to void, she holds her urine rather than pee.
Jeremy is a very busy five-year-old who wets his underwear during recess. Recess comes soon after snack, when Jeremy always drinks at least one, and sometimes two, milk cartons. He knows he should come in to pee, but playing soccer seems more important.
Paul is a shy eight-year-old boy who wets his underwear on the bus coming home after school. He never has enough time to get to the bathroom between the end of class and when he has to board the bus.
Nicole, a clumsy thirteen-year-old, comes home from school with wet panties almost every Thursday. She has a phys-ed class that afternoon. Several girls in her class make fun of her whenever she goes to use the bathroom.
In all of these cases, daytime wetting is partially due to poor access to a bathroom. Dozens of other common situations can limit bathroom access. Sometimes wetting happens only once, but other times it is more continuous and serious.
The bladder, a muscular sac, has a capacity that varies with age. When the bladder is full, a nerve signal travels to the spinal cord and from there to the brain. Ignoring the signal is not usually a good idea. The only place urine can go is out.
As the volume of urine in the bladder continues to increase, so does the pressure. Each signal becomes more urgent and intense. Tightening the pelvic floor muscles may help hold the urine in. If the bladder is not emptied, the bladder is forced to release some urine to reduce the pressure. This results in damp spots, or wetness visible through both the underwear and the pants, or a complete soaker.
Over time the bladder and pelvic floor muscles can become overdeveloped, much as any other muscle does with exercise. This can be a serious concern.
The best way to keep the bladder and bowels healthy is to pee and poop as soon as the signal is received!
Bladder infections are common, especially in girls. Peeing hurts since the germs irritate the bladder and the urethra (the tube that carries the urine from the bladder out of the body). The genital area is often red and sore because germs usually become established on the outside before they find their way to the bladder. Children with a bladder infection often have to pee more often since the infection makes the bladder act like it is small. They also have sudden urges to pee, and if they cannot make it in time, they wet their underwear.
Germs that cause bladder infection live in the bowel, where they play a role in digestion. Good wiping skills are important to reduce the risk of bladder infection. Children should be instructed to always wipe from the front to the back.
Careful rinsing of the genital area is important during the daily bath. Water without soap should be used. For girls, the genital lips should be spread to allow the water to rinse inside. For boys who are not circumcised, the foreskin should be washed carefully.
Children should change their underwear every day. Parents should routinely check underwear. Urine stains in the front mean the child is likely not passing urine often enough, and poop stains in the back mean the child is not wiping carefully. Green discharge in the front is a sign of infection.
Constipation is more common than most parents (and doctors) realize. Most children do not tell their parents how often they are pooping. The normal pattern is to have at least one soft, formed, bowel movement every day. This usually happens after a major meal. Hard, wide, difficult to pass and infrequent stool is common in children with constipation.
The bowel and the bladder lie side-by-side in the pelvis. Constipated stool in the bowel can press on the bladder and lead to day and nighttime wetting.
Solving the constipation riddle requires three things. First, the poop needs to be soft. This requires diet changes and a stool softener. Second, the child needs to recognize the signal of the need to poop and to go to the bathroom right away. Third, the child needs to use good posture to allow the pelvic floor muscles to relax and the poop to come out.
The best food choices are fresh fruit and vegetables, and whole grain breads and cereals. Oatmeal with raisins or some other fruit for breakfast is great. Popcorn is a good snack choice. Do not overdo dairy products, as they harden poop.
The trigger for the signal of the need to poop starts with a full stomach. When the stomach is full, it signals to the lower bowel to push the poop along and out. Snacking should be avoided, as it does not fill the stomach and does not lead to a good signal. A hearty breakfast that fills the stomach is a good start to the day. The signal usually follows the meal by about 15 minutes.
Breakfast should be eaten early enough so that the child has time to poop before leaving for school. Most children hate to poop at school. Holding it in all day at school is a common part of the constipation problem.
The best posture to empty the bowels requires an over-the-toilet seat and footstool for pre-school children. The heels should rest flat on the floor or stool. The underwear and pants should be pulled down to the floor so that the knees can relax outwards. A relaxed position while sitting, leaning a bit forward, and patience are required. Rushing and pushing do not help.
Other causes of daytime wetting
There are lots of other causes of daytime wetting, some of them potentially serious. Fortunately they are also uncommon. Only about one in 20 of the children with daytime wetting have a more serious problem. You can check for more serious problems by talking to your family doctor or pediatrician (a doctor who specializes in the care of children). A careful history, a thorough physical examination, and a urine test are all that are usually necessary.
Toilet training and preventing daytime wetting
Teaching children good bladder and bowel habits from early infancy is the best way to avoid daytime wetting problems. You can prevent problems in three major ways.
First, make going to the bathroom a priority for your child. Encourage your child to pee or poop as soon as the signal is present. Have your child pee before leaving the house. If you are at the mall, find a bathroom. If you are watching a video, pause the program, and make a trip to the bathroom.
Second, encourage good posture when going to the bathroom. An over-the-toilet seat and a footstool are necessary for all preschool children. Teach your child to always relax and take enough time for all the pee or poop to come out. Never rush. Never push.
Third, teach your child to use good genital hygiene every day.
Daytime wetting is common in pre-school and elementary school aged children. It is usually due to poor voiding habits, a bladder infection, or constipation, and usually responds well to simple therapies.