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Day wetting

  • Practical Pediatric Nephrology
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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.

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References

  1. Ollendick TH, King NJ, Frary R (1989) Fears in children and adolescents: reliability and generalizability across gender, age and nationality. Behav Res Ther 27: 19–26

    Google Scholar 

  2. Roberts KE, Schoellkopf JA (1951) Eating, sleeping and elimination practices of a group of two-and-one-half-year-old children. Am J Dis Child 82: 121

    Google Scholar 

  3. Oppel WC, Harper PA, Rider RV (1968) The age of attaining bladder control. Pediatrics 42: 614–626

    Google Scholar 

  4. Miller FJW, Court SDM, Walton WS, Knox EG (1960) Growing up in Newcastle upon Tyne. Oxford University Press, London, p 150

    Google Scholar 

  5. Stein ZA, Susser MW (1967) Social factors in the development of sphincter control. Dev Med Child Neurol 9:692–706

    Google Scholar 

  6. Cooper CE (1973) Giggle micturition. In: Kolvin I, MacKeith RC, Meadow SR (eds) Bladder control and enuresis, Heinemann, London, p 61

    Google Scholar 

  7. Glahn BE (1979) Giggle incontinence (enuresis risoria). A study and an aetiological hypothesis. Br J Urol 51: 363–366

    Google Scholar 

  8. Brocklebank JT, Meadow SR (1981) Cure of giggle micturition. Arch Dis Child 56: 232–234

    Google Scholar 

  9. Millard DW (1966) Case histories and short communications. A conditioning treatment for “giggle micturition.” Behav Res Ther 4: 229–231

    Google Scholar 

  10. Notschaele LA (1964) Bed welting in children from junior to senior school (in Dutch) Tijdschr Soc Geneesd. 42: 226

    Google Scholar 

  11. Bloomfield JM, Douglas JWB (1956) Bedwetting: prevalence among children aged 4–7 years. Lancet I: 850–852

    Google Scholar 

  12. Hallgren B (1956) Enuresis. I. A study with reference to the morbidity risk and symptomatology. Acta Psychiatr Neurol Scand 31: 379–403

    Google Scholar 

  13. Hallgren B (1956) Enuresis. II. A study with reference to certain physical, mental and social factors possibly associated with enuresis. Acta Psychiatr Neurol Scand 31: 405–436

    Google Scholar 

  14. Jonge GA de (1973) Epidemiology of enuresis: a survey of the literature. In: Kolvin I., MacKeith RC, Meadow SR (eds) Bladder control and enuresis. Heinemann, London, p 39

    Google Scholar 

  15. Forsythe WI, Redmond A (1974) Enuresis and spontaneous cure rate: study of 1129 enuretics. Arch Dis Child 49: 259–263

    Google Scholar 

  16. Hallgren B (1957) Enuresis: a clinical and genetic study. Acta Psychiatr Neurol Scand 32 [Suppl 114]: 1–159

    Google Scholar 

  17. Van Gool JD, Jonge GA de (1989) Urge syndrome and urge incontinence. Arch Dis Child 64: 1629–1634

    Google Scholar 

  18. Berg I, Fielding D, Meadow SR (1977) Psychiatric disturbance, urgency and bacteriuria in children with day and night wetting. Arch Dis Child 52: 651–657

    Google Scholar 

  19. Savage DCL, Wilson MI, Ross EM, Fee WM (1969) Asymptomatic bacteriuria in girl entrants to Dundee primary schools. Br Med J 3: 75–80

    Google Scholar 

  20. Meadow SR, White RHR, Johnston NM (1969) Prevalence of symptomless urinary tract disease in Birmingham schoolchildren. I. Pyuria and bacteriuria. Br Med J 3: 81–84

    Google Scholar 

  21. Jones B, Gerrard JW, Shokeir MK, Houston CS (1972) Recurrent urinary infections in girls: relation to enuresis. CMA 106: 127–130

    Google Scholar 

  22. Halliday S, Meadow SR, Berg I (1987) Successful management of daytime enuresis using alarm procedures: a randomly controlled trial. Arch Dis Child 62: 132–137

    Google Scholar 

  23. Yeates WK (1973) Bladder function: increased frequency and nocturnal incontinence. In: Kolvin I, MacKeith RC, Meadow SR (eds) Bladder control and enuresis. Heinemann, London, p 151

    Google Scholar 

  24. Taylor CM, Corkery JJ, White RHR (1982) Micturition symptoms and unstable bladder activity in girls with primary vesicoureteric reflux. Br J Urol 54: 494–498

    Google Scholar 

  25. Allen TD (1977) The non-neurogenic neurogenic bladder. J Urol 117: 232–238

    Google Scholar 

  26. Hinman F Jr, Bauman FW (1973) Vesical and ureteral damage from voiding dysfunction in boys without neurologic or obstructive disease. J Urol 109: 727–732

    Google Scholar 

  27. Koff SA (1982) Bladder-sphincter dysfunction in childhood. Urology 19: 457–461

    Google Scholar 

  28. Siroky MB, Krane RJ (1982) Neurologic aspects of detrusor-sphincter dys-synergia, with reference to the guarding reflex. J Urol 127: 953–957

    Google Scholar 

  29. Linderholm BE (1966) The cystometric findings in enuresis. J Urol, 96: 718–722

    Google Scholar 

  30. Ramsden PD, Smith JC, Dunn M, Ardran GM (1976) Distension therapy for the unstable bladder: later results including an assessment of repeat distension. Br J Urol 48: 623–629

    Google Scholar 

  31. Borzyskowski M, Mundy AR (1987) Videourodynamic assessment of diurnal urinary incontinence. Arch Dis Child 62: 128–131

    Google Scholar 

  32. Whiteside CG, Arnold EP (1975) Persistent primary enuresis: a urodynamic assessment. Br Med J 1: 364–367

    Google Scholar 

  33. Koff SA, Lapides J, Piazza DH (1979) Association of urinary tract infection and reflux with uninhibited bladder contractions and voluntary sphincter obstruction. J Urol 122: 373–376

    Google Scholar 

  34. Jonge GA de (1973) The urge syndrome. In: Kolvin I., MacKeith RC, Meadow SR (eds) Bladder control and enuresis. Heinemann, London, p 66

    Google Scholar 

  35. Fielding DM (1978) An investigation of some factors influencing the classification and treatment of childhood enuresis with special reference to day-time wetting. PhD Thesis, University of Leeds

  36. Hallman N (1950) On the ability of enuretic children to hold urine. Acta Paediatr 39: 87–93

    Google Scholar 

  37. Starfield B (1967) Functional bladder capacity in enuretic and nonenuretic children. J Paediatr 70: 777–781

    Google Scholar 

  38. Vincent SA (1966) Postural control of urinary incontinence: the curtsey sign. Lancet II: 631–632

    Google Scholar 

  39. Fielding DM, Berg I., Bell S (1978) An observational study of postures and limb movements of children who wet by day and at night. Dev Med Child Neurol 20: 453–461

    Google Scholar 

  40. Fielding DM (1982) An analysis of the behaviour of day and night wetting children: towards a model of micturition control. Behav Res Ther 20: 49–60

    Google Scholar 

  41. Butcher C, Donnar D (1972) Vaginal reflex and enuresis. Br J Radiol 45: 501–502

    Google Scholar 

  42. Koff SA (1988) Evaluation and management of voiding disorders in children. Urol Clin North Am 15: 769–775

    Google Scholar 

  43. Meadow R, Berg I (1982) Controlled trial of imipramine in diurnal enuresis. Arch Dis Child 57: 714–716

    Google Scholar 

  44. Ulmsten U, Ekman G, Andersson KE (1985) The effect of terodiline treatment in women with motor urge incontinence. Am J Obstet Gynecol 193: 619–622

    Google Scholar 

  45. Tapp AJS, Cardozo LD (1986) The postmenopausal bladder. Br J Hosp Med 35: 20–23

    Google Scholar 

  46. Cardozo LD (1988) Biofeedback. In: Freeman R, Malvern J (eds) The unstable bladder. Wright, London, p 61

    Google Scholar 

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Authors and Affiliations

  1. Department of Paediatrics and Child Health, St. James's University Hospital, LS9 7TF, Leeds, UK

    S. R. Meadow

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  1. S. R. Meadow
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Meadow, S.R. Day wetting. Pediatr Nephrol 4, 178–184 (1990). https://doi.org/10.1007/BF00858838

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  • DOI: https://doi.org/10.1007/BF00858838

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