Talk to Laurie* of New Hampshire about her 9-year-old daughter, Veronica, who still wets her pants both day and night, and you'll hear the years of built-up tension oozing out of every fiber of her body.
"This has been such a huge battle," she says. "It has frustrated me to no end.'' Veronica, ready to enter the third grade this fall, has been wetting herself for five years.
The family's first doctor medicated Veronica, saying the child's bladder was "too tight,'' had lost all sensation and was pushing out any urine. But a year and a half of driving two hours each way to the doctor's office every three months, plus the fact that the drugs didn't seem to be working, propelled Laurie to find a second opinion. The new doctor told Laurie her daughter's daytime wetting problem had now become a physiological difficulty. This doctor didn't prescribe any drugs but strongly encouraged that Veronica empty her bladder every two hours, getting into the practice of going to the bathroom.
Laurie has used many methods designed to make potty training fun. "I've tried stickers and rewards and everything,'' she says. "Now, I say, 'You have no choice. Just get in there and go.'''
Veronica has two things in her favor that may help her change her habits: First, Laurie says, Veronica is finally getting old enough so that she's embarrassed when she walks around school with wet pants. And second, Laurie's 2-year-old is also learning to be potty trained, so Veronica and her younger sibling are working on the same issue together.
According to the Mayo Clinic in Rochester, Minn., a survey of 2,000 children in 1990 showed that wetting pants in class was the third biggest fear among school-aged children, just behind losing a parent or going blind.
Daytime wetting commonly appears in children ages 3 to 5 who have been successfully toilet trained, but who now see going to the bathroom as a lower priority than playing games or doing other fun activities. While absorbed in a riveting game of Nintendo or stickball, sometimes children opt for what urologists call micturition deferral or "holding it." Putting off a trip to the bathroom is probably the most common cause of daytime wetting among preschoolers, according to the Mayo Clinic. Other possible causes include excessive laughter or excitement; stressful events like the birth of a baby brother or sister; constipation, which may cause a child to avoid going to the bathroom; and external genital irritation from soap or bubble baths.
Wearing disposable absorbent underpants while working on the problem can be helpful. Children save face if they have an accident at school, avoiding the telltale wet bottom or odor. This may even improve a child's self-esteem.
Bedwetting vs. Day Wetting
According to Dr. Robert Mevorach, a pediatric urologist at the University of Rochester in New York, there is no inherent connection between day wetting, which he views as the more complicated problem, and bedwetting, which he describes as mono-symptomatic.
Day wetting, which is formally called diurnal enuresis, can result from an unusual and severe neurological problem, according to Dr. Mevorach. But the majority of day wetters have patterned themselves to simply hold it in all day, waiting until the last minute. So when they finally get the signal to urinate, he says, it has become practically an emergency, and they inevitably leak from a little to a lot.
Encouraging Dry Days
Dr. Mevorach says the first and best tool for retraining a bladder is what Veronica is currently practicing: timed bathroom excursions every two hours, like it or not. This helps the child get used to releasing her bladder. The child is already used to holding it in, and now the reverse has to happen, he says.
The best trick for a positive outcome, Dr. Mevorach says, is a positive attitude. "Get them to start believing that they can accomplish something,'' he says. "And that might be a toughie.''
If the child has gym class or a soccer game, she must know that before heading out to the field, heading into the bathroom is a must. "They've just got to anticipate the problem before it occurs,'' Dr. Mevorach says.
While Veronica is having some success (she's stayed dry for the past week), she will be spending the rest of the summer potty training. Hopefully, Laurie says, Veronica will have success before school starts, because it is difficult to rely on the teachers to make sure Veronica leaves class regularly for a bathroom break. She's also hoping peer pressure will play a role in her daughter's evolution.
* Last name withheld to protect privacy.