A mother brought her four year old daughter “Jane” in to the Clinic because she expected that Jane should be ‘dry’ at night. She wanted to know whether she should buy a night time ‘pee alarm’ to put in to her daughters undies or try a TENS machine to help settle Detrusor muscle overactivity (the Detrusor is smooth muscle found in the wall of the bladder and it contracts during urination to allow the release of urine).
Since Jane stopped day time nappies at age three her mother suspected that she may have an overactive bladder as she experienced regularly episodes of urinary urgency throughout the day with frequent accidents. Her mother had initially thought that her daughter was being lazy and simply avoiding going to the toilet! The urgency symptoms lasted for approximately 15 months and gradually resolved. Her mother was hoping that her night time continence would also resolve but this did not appear to be he case.
TENS stimulation can be really helpful to modulate neural information to the Detrusor muscle and help settle overactivity, but as Jane’s urgency symptoms had appeared to settle it was not currently indicated. Instead our Physiotherapists who specialise in continence wanted to understand Jane’s daytime urinary habits and she (and her mother) were sent away to complete a bladder diary. This involved weighing her morning nappy and recording urine volume through out the day. Jane did not have increased urine volumes in the morning (a condition known as Polyuria where there is excessive urine production), but instead had only 50% of ‘normal’ bladder volume.
Before addressing any night time issues, their first task was to spend the next 2-3 weeks working on increasing Jane’s fluid intake. If the bladder is not trained to hold more fluid, then the Detrusor is not adequately challenged and this will affect bladder dynamics. We suspect that because of Jane’s urgency symptoms that she was asked to go to the toilet frequently to prevent her having an accident, and that this has inadvertently stopped Jane training her bladder to fill normally.
Jane and her mother will complete another bladder diary before returning for their next appointment. Once bladder compliance has improved we may see a natural resolution to Jane’s night time issues. We will keep you posted.
It may be absolutely normal for a four year old to still wear a night time nappy, and most children seem to come out of night nappies at around 3 to 4 years of age, if you are concerned it is certainly worth checking for conditions like Polyuria, Overactive Bladder Syndrome or issues such a constipation that may affect normal bladder function.
If you are concerned, call the clinic and make an appointment with Ellen or Chloe.