Assessment of Childhood Daytime Urinary Incontinence
Indications
• A child >5 years old with daytime urinary incontinence (DUI)
• ≥ 1 times per month for ≥ 3 months
Aim
• Identify underlying neurological/anatomical causes of DUI that require referral to specialist services
• Facilitate diagnosis of the correct functional cause of DUI
• Prevent over investigation and examination
• To guide an appropriate stepwise management plan
• Diagnostic signs that indicate possible underlying Red flag signs (organic causes) are written in red
throughout this guideline
Medical History
• Obstetric History
• Developmental milestones
• Age at which continence was achieved
• Previous relevant surgery
• Family History
Consider underlying anatomical
• Recurrent proven urinary tract infections cause, chronic illness or renal
• Excessive tiredness impairment
• Menstrual and sexual history
Bladder Specific History
Consider underlying anatomical
• Is incontinence continuous or intermittent? cause – refer to paediatric
• Is it primary or secondary? urologist
• Establish lower urinary tract symptoms (LUTS)
Identify and treat existing co-morbidities
Treat as per NICE guideline 99
• Constipation
• Urinary tract infection Treat as per NICE guideline 54
• Nocturnal enuresis
Treat as per NICE guideline 111
Physical examination
Faltering growth / weight loss /
• Height, Weight, and BP hypertension
Bladder distension / Renal mass
• Abdominal palpation
Missing sacral segments / deep
• Evaluation of spine (bony & cutaneous) sacral dimple / lipoma / vascular
skin discolouration / hair tuft /
impaired ability to bend at wait
• Examination of lower extremities
Muscle atrophy / foot deformity /
• Genital examination foot drop / asymmetry of
buttocks or lower limbs
/disturbance of gait
Assessment of Childhood Daytime Urinary Incontinence
Bladder Diary
Completed for 2 days they do not need to be consecutive
days but should document: Polydipsia or polyuria –
• Episodes of urgency +/- urge incontinence consider diabetes mellitus /
• Size of incontinence episode insipidus, renal tubular disease
• Fluid intake (time, type and volume) or psychogenic causes
• Every void day and night (time & volume)
Bowel Diary
Complete for seven consecutive days and document: If constipated take full bowel
• Every stool passed day and night including timing history to identify red flags of
• Type of stool as per Bristol stool chart delayed passage of
• Amount of stool meconium / constipation
• Any episodes of soiling from birth / ribbon stools
Behaviour / Lifestyle
Establish any life altering event such as:
• Death in the family Deliberate wetting
Encopresis / deliberate
• Divorce / parental separation
smearing
• Birth of a sibling Urinary retention
• School moves, problems or bullying Chronic lower abdominal
• Home environment / housing pain (PID)
Establish any mental health or safeguarding issues:
Investigations
Only routine investigation is a urinalysis to rule out UTI: Haematuria / proteinuria /
• If leucocytes and nitrites positive – send fresh clean glycosuria may suggest
urine sample for culture underlying condition and
• Bacteriuria in a non febrile child does not require require further investigation
antibiotics
Ultra Sound Scan is not routinely required at initial
assessment but is indicated if: Upper tract dilation can
• Continuous incontinence signify increased bladder
storage pressures +/-
• Recurrent UTIs
bladder outlet obstruction
• Initial behavioural management is failing
Pre and post void scans should be requested