Daytime urinary incontinence in children can develop due to many reasons and may be a sign of various diseases. First, the relevant physician should determine whether the incontinence is due to physiological, anatomical, neurological, or psychological/behavioral (such as attention deficit/hyperactivity disorder) causes. Common causes of daytime urinary incontinence include congenital malformations (birth-related anatomical problems, e.g., ectopic ureter, exstrophy variants, etc.), diabetes mellitus, overactive bladder (small bladder capacity/volume), sudden and uncontrollable urge to urinate, urinary tract infections, residual urine after voiding, urine withholding behavior, underlying constipation, neurogenic bladder (spina bifida, cerebral palsy, spinal cord injuries, etc.), and developmental deficiencies.

Contrary to popular belief, daytime urinary incontinence in children is a frequently occurring but often undiscussed or stigmatized urological health issue. Research indicates that the prevalence of daytime urinary incontinence is approximately 2.1% to 21.8%. In scientific studies conducted in Turkey, this rate is reported as 8 out of 100 children. The condition is twice as common in girls as in boys and typically occurs in elementary and middle school-aged children (6-14 years).

According to the latest guidelines from the International Children's Continence Society and the European Association of Urology, children aged 5 or older who experience daytime urinary incontinence at least once a month for at least 3 months should be evaluated and treated by pediatric urology departments. If your child is under 5 years old, they may not have fully developed bladder control physiologically and neurologically. However, since daytime urinary incontinence could indicate other underlying conditions, it must be evaluated by a physician. Therefore, raising parental awareness for early diagnosis is crucial.

First, the cause and severity of urinary incontinence should be evaluated by a physician. In this regard, a detailed history and physical examination by a pediatric urology specialist are invaluable. The detailed history should include medical background (medications used, past surgeries, related health problems, etc.), voiding and defecation habits, eating and drinking habits, toilet training, and presence of accompanying psychological problems. During the physical examination, the genital anatomical structures and the lumbar region where the nerve bands controlling the bladder pass are checked, and an MRI may be requested if necessary.

• Urinalysis and urine culture may be requested by your physician if a urinary tract infection is suspected.
• Blood tests may be ordered by the pediatric urologist to evaluate infections, investigate metabolic disorders, check hormonal imbalances, and assess kidney functions.
• Kidney and bladder ultrasound is a very easy and practical imaging technique that provides information about kidney enlargement (hydronephrosis) and anatomical changes (e.g., cystic structures). It is also used to detect post-void residual urine and bladder wall thickness, as well as fecal masses in the rectum suggesting constipation.
• Voiding test (urine flow test/uroflowmetry) is another simple method that provides physicians with information about bladder emptying. The test is performed when the child feels the urge to urinate, using a special sensor-equipped toilet-like computerized system. No medical equipment enters the body during the procedure, making it painless and often described as fun by children.
• Bladder diary (2-day voiding diary) is an important assessment tool that provides detailed information to healthcare professionals about children with urinary incontinence. It records how many times the child urinates per day, the amount of urine each time (cc or ml), the number of daytime incontinence episodes, and the type and amount of fluid consumed. Parents are recommended to assist younger children in filling it out. The diary should be filled naturally without interfering with the child's fluid intake or toilet habits. Click to access DryKids®'s 2-day bladder diary.
• Bowel diary (7-day defecation diary) is typically described as fun by children and records defecation times and stool consistency for a week when constipation is suspected. It provides detailed information to healthcare professionals about the child's bowel movements. If the child also has fecal incontinence, relevant notes should be added to the diary. Click to access DryKids®'s 7-day bowel diary.
• Urodynamics is a test that provides important information about the bladder's storage (filling) phase, especially in children with daytime urinary incontinence due to neurogenic bladder. A small catheter is inserted to measure bladder pressure, capacity, and identify the cause of incontinence. It is not required for every patient.

Pediatric urologists determine appropriate tests based on the child's age, complaints, and clinical condition, evaluate the results, and plan the best treatment approach.

Yes, in some special cases, daytime urinary incontinence in children can be attributed to psychological and behavioral factors.

Particularly, family changes (e.g., divorce, relocation, new sibling, death, etc.), school stress, peer relationship problems, and similar situations that may cause stress and anxiety in children can lead to urinary incontinence. Additionally, traumatic events (sexual and/or physical trauma), violence, and bullying can also cause incontinence. In such cases, psychological support therapies should be added alongside pediatric urology treatment to manage the process more quickly and safely.

However, it should not be forgotten that 95% of daytime urinary incontinence cases develop due to urological reasons, while the remaining 5% are attributed to psychological causes. Studies have shown that children with untreated or delayed treatment for urinary incontinence develop self-confidence loss, social isolation, introversion, anger, anxiety, and sadness, and their academic success is lower than their peers without incontinence. Therefore, delayed treatment of urinary incontinence problems can lead to additional psychological issues, making treatment more complex. As a result, children with daytime urinary incontinence should first be evaluated by pediatric urology departments and referred to relevant healthcare professionals when necessary.

Treatment for daytime urinary incontinence may vary depending on accompanying complaints, underlying causes, and the severity and amount of leakage. Planning each child's treatment individually and according to family dynamics is crucial for successful completion. Studies emphasize that multimodal treatments (simultaneous interventions) for daytime urinary incontinence often have higher success rates due to underlying complex conditions. Primarily, treating urinary tract infections and constipation, which are among the causes of daytime urinary incontinence, is important.

• Urotherapy Training (Healthy Bladder & Bowel Training) is an education provided by specialist physiotherapists targeting behavioral changes in children and families. The training includes proper toilet posture, healthy eating and drinking habits, age-appropriate fluid intake, healthy bladder and bowel emptying techniques, scheduled voiding times, etc. The content varies according to each child's complaints and needs.
• Medication Treatments may be prescribed by pediatric urologists depending on the type, severity, and amount of incontinence. These medications help relax the bladder wall muscle (detrusor) and/or bladder neck by preventing excessive contractions. Prophylactic (preventive) antibiotics may also be used to protect the upper urinary system (kidneys) in children with recurrent urinary tract infections. Medication treatments should be determined by the relevant specialist physician and monitored according to the patient's complaints.
• Pelvic Floor Muscle Rehabilitation is a method applied by specialist physiotherapists to retrain the pelvic floor muscles responsible for urination and defecation. Through this training, children's ability to retain urine healthily and resist sudden urges to urinate is improved. Pelvic floor rehabilitation includes massage techniques, diaphragmatic breathing exercises, biofeedback-assisted pelvic floor muscle exercises, stabilization exercises, neuromodulation techniques, etc., and is applied under the guidance of specialist physiotherapists.

Delayed treatment or untreated daytime urinary incontinence can eventually affect the child's psychology, causing self-confidence loss, decreased self-esteem, social isolation, introversion, anger, anxiety, sadness, and other emotional problems, making the problem grow and its solution more complex.

Problems that start with a few drops of urine leakage may increase in severity over time, making the child unable to suppress sudden urges to urinate, worsening the condition. In cases of underlying pelvic floor muscle dysfunction, it may even lead to fecal incontinence or inability to defecate. Particularly, delaying treatment for children with post-void residual urine may increase the amount of residual urine, potentially causing kidney reflux and kidney damage in the long term.

Daytime urinary incontinence, even if just a few drops, is a health problem that should be treated without delay by seeking support from pediatric urology departments.