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Tuesday, September 2, 2014
Urinary and Genital Disorders (Children)
My daughter is four years old. She has been potty trained from about the age of 2 and half, although from this time she has always had problems wetting herself during the day and at night. I got her kidneys checked out and they are fine. It is really starting to worry me now, could there be something more serious wrong with her?
Involuntary wetting (also called urinary incontinence) is a normal developmental stage. When it is present beyond a certain age defined by parental and societal expectations it can cause concern and anxiety in a child and family.
Being able to control urination depends on normal bladder function and normal urine production. It relies on the ability of the bladder to store urine without leakage, empty completely and a child’s ability to interrupt urination voluntarily.
Evaluation of this problem, like any other medical condition, should begin with a careful history. In this case important questions might include: Is the child over producing urine that is causing problems both day and night? This is best determined by checking if the volume of fluid taken by the child seems excessive rather than trying to estimate the volume of urine output. Does the child seems continuously hungry or thirsty, seek water in unusual places like toilets or frequently wake up at night to drink?
There are a several diseases that can cause excessive drinking and over production of urine including diabetes mellitus. Poor weight gain, failure to grow normally, headaches, fatigue, involuntary loss of stool, painful urination, frequent urination and the sudden urge to urinate followed by incontinence may be important clues.
Secondary enuresis is defined as enuresis occurring after dry period of at least 3-6 months and can be first sign of acquired kidney or other diseases. Fecal soiling or constipation may raise the suspicion of a spinal lesion. Continuous dribbling may be a sign of primary bladder or kidney problems. The child should be carefully examined by a physician for high blood pressure, with careful evaluation of the lower back, feet and lower extremities.
Since this child has problems with wetting both awake and asleep this is not simply primary sleep bedwetting (enuresis) which is normal at this age. I would suggest that you discuss your concerns about your child’s issue with a pediatrician.
Mark Splaingard, MD
Clinical Professor of Pediatrics
College of Medicine
The Ohio State University