Mary N. posted this question: “I have a 3 1/2 year old son that urinates a lot. He is more thirsty and drinks a little more than his siblings, but he goes to the bathroom hourly, to the point that a friend commented today about it. We also wake him up to go to the bathroom at 10 pm, he wakes himself up around 1 am, and he still often wakes up wet. Is there something to be concerned about here?”
I see kids like this several times a year. If you like playing the odds, I can promise you up front that it is very unlikely that there is anything serious going on. But there are some rare medical conditions that can lead to big problems if the diagnosis is delayed, so it is important for you to visit the doctor for some basic tests to make sure nothing much is going on.
The most common cause of frequent urination is having dilute urine—that is, drinking a lot. I’ve heard it said that adults 8 glasses of water each day, which very few of us do. So I sometimes suspect that these “big drinkers” are probably doing better than most of us. They drink a lot, they urinate a lot, and that’s probably good for them!
Another common cause is called “dysfunctional voiding.” This begins, in a way, as a habit that then leads to physical changes in the bladder. Young children will often go through phases of holding their urine too long—they’re in a hurry, and they don’t want to stop something fun to urinate. They sometimes don’t want to urinate in public places, or at school. Sometimes, they’re willing to urinate, but they don’t completely empty their bladder. It’s just not something children want to wait for! When the bladder stays full, or doesn’t empty, the bladder walls become thick and more muscular. This can lead to “bladder spasms,” which can be felt as a sudden and sometimes uncomfortable urge to quickly run to the bathroom. A big, over-full bladder can’t empty well, even when a child tries. Also, many children who hold their urine also hold their stool, and a big mass of stool in the pelvis presses on the bladder, preventing it from filling completely and emptying completely.
If your child has dysfunctional voiding, there are a number of strategies to help work through this. Make sure that he has easy access to a bathroom at all times. Gently encourage him to use the bathroom frequently, at least every two hours (sometimes it helps to use a kitchen timer.) Allow him to bring a favorite toy or game into the bathroom so he’ll slow down and relax. Sometimes, it’s a good idea to encourage boys to sit down, which prevents them from rushing. You can also encourage children to “pee twice” every time (that is, try to pee more after a minute’s break.) Girls can be encouraged sit sit facing backwards, which opens up the bladder well and prevents them from jumping up off the toilet too quickly. You also want to encourage lots of fluids to drink, so they can practice peeing well more frequently. If there is stool holding or constipation, that has to be addressed as well.
As I mentioned, there are more rare causes of urinary frequency that need to be “ruled out.” These include infection, diabetes mellitus, and very rarely diabetes insipidus (where the kidneys cannot make concentrated urine.) These can usually quickly be evaluated with a simple urine test, and perhaps a quick blood test. So though the common causes of frequent urination are not serious, the situation you describe does warrant a visit to the doctor.
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