A bladder that does not empty completely (neurogenic bladder) because of a spinal cord or nervous system defect

Obvious abnormalities in the spine, a dimple or hair tuft in the lower back, and weakness and decreased sensation in the legs and feet

X-rays of the lower back

Sometimes MRI of the spine

Ultrasonography of the kidneys and bladder

Studies of urine flow and pressure in the bladder (urodynamic studies)

Anatomic abnormality (for example, a misplaced ureter in girls)

Complete daytime continence never achieved

In girls, daytime and nighttime incontinence, a history of normal voiding but with continually wet underwear, and a discharge from the vagina

Possibly a history of urinary tract infections and of other urinary tract abnormalities

Imaging studies of the kidneys and ureters, including ultrasonography of the kidneys

CT of the abdomen and pelvis or MRI of the urinary tract

Often a voiding cystourethrogram (x-rays taken before, during, and after urination)

An overfull bladder

Waiting to the last minute to urinate

Common among preschool children when they are absorbed in playing

Questions about when incontinence occurs

Recording the timing, frequency, and volume of urine in a journal (voiding diary)

Back up of urine into the vagina (urethrovaginal reflux, or vaginal voiding)

Dribbling when standing after urination

A doctor's examination alone

Constipation

Infrequent, hard, pebblelike, or very large stools

Sometimes abdominal discomfort

Often in children who consume a constipating diet (for example, excessive milk and dairy products and few fruits and vegetables)

Usually a doctor's examination alone

Sometimes an x-ray of the abdomen

Recording the timing, frequency, and volume of stool in a journal (stooling diary)

Dysfunctional voiding because the muscles involved in expelling urine from the bladder (the bladder muscle and urinary sphincter) are not coordinated

Sometimes stool incontinence and frequent urinary tract infections

Possibly daytime and nighttime incontinence

Studies of urine flow

Sometimes a voiding cystourethrogram (x-rays taken before, during, and after urination)

Ultrasonography of the kidneys and bladder

Giggle incontinence

Urinating while laughing, almost exclusively in girls

At other times, completely normal urination

A doctor's examination alone

Increased urine output, which can have many causes, such as

• Diabetes mellitus

• Argininevasopressin deficiency (central diabetes insipidus)

• Nephrogenic diabetes insipidus

• Excessive water intake

• Sickle cell disease or trait

Vary by disorder

For diabetes mellitus, urine tests for glucose (sugar) and ketones and/or a blood test†

For diabetes insipidus or sickle cell disease, blood tests

Overactive bladder

A need to urinate urgently (essential for diagnosis)

Commonly a frequent need to urinate during the day and night

Sometimes use of holding maneuvers or body posturing (for example, children may squat)

A doctor's examination

Sometimes studies of urine flow, urodynamic studies, voiding diary

Sexual abuse

Sleep problems or school problems (such as delinquency or poor grades)

Inappropriate and sexualized behavior, depression, an unusual interest in or avoidance of all things sexual, and inappropriate knowledge of sexual things for age

Evaluation by sexual abuse experts

Stress‡

School problems, social isolation or problems, and family stress (for example, divorce or separation of the parents)

A doctor's examination alone

Urinary tract infection

Pain while urinating, blood in the urine, a need to urinate frequently, and a sense of needing to urinate urgently

Sometimes fever, abdominal pain, and/or back pain

Urine culture and urinalysis

If urine culture and urinalysis results are positive and especially if kidney infection, possible ultrasonography and voiding cystourethrogram (x-rays taken before, during, and after urination)