Some Causes and Features of Daytime Incontinence in Children
Cause |
Common Features* |
Tests |
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Infrequent, hard, pebblelike stools Sometimes abdominal discomfort Often in children who consume a constipating diet (for example, excessive milk and dairy products and few fruits and vegetables) |
A doctor's examination Sometimes an x-ray of the abdomen Stooling diary |
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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 |
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Giggle incontinence |
Urinating while laughing, almost exclusively in girls At other times, completely normal urination |
A doctor's examination |
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Increased urine output, which can have many causes, such as |
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 |
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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) |
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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) |
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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, voiding diary |
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Sleep problems or school problems (such as delinquency or poor grades) Seductive 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 |
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Stress‡ |
School problems, social isolation or problems, and family stress (for example, divorce or separation of the parents) |
A doctor's examination |
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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 sometimes CT of the abdomen and pelvis or MRI of the urinary tract |
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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 tests If results are positive, further evaluation |
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Back up of urine into the vagina (urethrovaginal reflux, or vaginal voiding) |
Dribbling when standing after urination |
A doctor's examination |
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* Features include symptoms and the results of the doctor's examination. Features mentioned are typical but not always present. |
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† Diabetes does not typically cause incontinence until blood sugar (glucose) levels are high enough to cause glucose to enter the urine. |
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‡ Stress is a cause primarily when incontinence is sudden. |
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CT = computed tomography; MRI = magnetic resonance imaging. |
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