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- Daytime wetting in a child ≥5 years of age warrants evaluation.
- Causes of functional incontinence include an array of bladder storage and voiding disorders.
- Voiding dysfunction is abnormal behavior of the lower urinary tract without a recognized organic cause, generally in the form of pelvic floor hyperactivity or bladder–sphincter discoordination.
- Bowel bladder dysfunction (BBD) describes the association between abnormal bladder and bowel behavior.
- Studies in children 6 to 7 years of age have shown that 3.1% of girls and 2.1% of boys had an episode of wetting at least once per week.
- Daytime incontinence is 2 to 5 times more common in girls than boys from age 7 years to adolescence.
- Spontaneous cure rate of 14% per year without treatment
- Of all children who wet, 10% have only daytime wetting, 75% wet only at night, and 15% wet during the day and at night.
- Recurrent urinary tract infections (UTIs)
- Diabetes mellitus/diabetes insipidus
- Attention deficit disorder (ADD)/attention deficit hyperactivity disorder (ADHD)
- Neurodevelopmental conditions
- Developmental delay
- History of abuse
- Only anecdotal relationships have been seen in functional daytime incontinence, unlike studies showing genetic tendencies in nocturnal enuresis.
- Increased rates of daytime wetting have been reported in:
- Urofacial (Ochoa) syndrome, an autosomal recessive condition
- Williams syndrome, which is the result of a deletion involving the elastin gene in chromosome 7
- Detrusor instability or over active bladder (OAB), which results from involuntary and uninhibited detrusor contractions during bladder filling
- Dysfunctional voiding, or detrusor sphincter discoordination, caused by incomplete relaxation of the pelvic floor muscles during urination and often resulting in incomplete bladder emptying
- Detrusor underactivity characterized by a large capacity, hypotonic bladder. This condition may be the result of longstanding dysfunctional voiding or voiding postponement.
- Neurogenic bladder
- Bladder irritability caused by UTI
- Increased urinary output—polyuria
- Infrequent or deferred voiding
- Overactive bladder
- Low functional bladder capacity, with detrusor instability during filling
- Vaginal reflux
- Giggle incontinence
- Temperamental factors (e.g., short attention span, inattentiveness to body signals) in children who ignore the urge to void
- Developmental differences in age at which toilet training is achieved
- Obstructive uropathy (e.g., posterior urethral valves)
- Neurogenic bladder (e.g., myelomeningocele)
- Anatomic anomalies (e.g., ectopic ureter)
Commonly Associated Conditions
- Constipation (common)
- Nocturnal enuresis (common)
- UTIs (common)
- Vesicoureteral reflux is more common in children with voiding dysfunction due to elevated detrusor pressures that overcome a marginal vesicoureteral junction.