Enuresis (involuntary peeing that is abnormal for a child’s age) is one of the most common types of voiding dysfunction, and includes both nighttime wetting (nocturnal enuresis) and daytime wetting (diurnal enuresis).
Children often exhibit posturing behaviors, (pee-pee dance, cross their legs, squat). Although it is normal for very young children to do this as they are learning to toilet train, sometimes these symptoms can continue even as the child grows older.
Voiding dysfunction may cause a child to run to the bathroom frequently. Children may have to urinate every 10-30 minutes or in less severe cases, every 1-3 hours. They will often urinate small volumes or feel the urge to urinate again soon after voiding.
What causes voiding dysfunction?
The bladder is a muscle that stores urine, and it empties by contracting the muscle. A normally functioning bladder only contracts when it is at full capacity (the normal amount of urine that it can hold comfortably) and it is time to void.
When the bladder is irritable or overactive, it tends to contract at will, regardless of how much urine it is holding. It’s important for you to know that what your child is feeling is real and they do not have conscious control over it.
Constipation often contributes to these symptoms of voiding dysfunction. Your child may have mild to moderate constipation without complaining and the rectum and colon can stretch to accommodate the stool. This causes pushing on the bladder resulting in urgency/frequency, a decrease in capacity, and incomplete emptying.
How is voiding dysfunction diagnosed and treated?
In diagnosing overactive bladder, your Nemours pediatric urology team will do few things to rule out infection, or any serious, but rare, disorder:
thorough health history
urinalysis and urine culture
renal and bladder ultrasound to check for bladder and kidney abnormalities
urine flow study (which uses a special toilet to measure your child’s voiding pattern)
post void residual (similar to the ultrasound, this is done after voiding to make sure your child is able to empty his or her bladder completely)
We will also ask you to keep a Voiding/Bowel Diary (PDF). This diary provides invaluable information that helps our Nemours pediatric urologists assess your child’s exact voiding problem. It will tell us how frequently your child is voiding, how much their bladder is letting them hold, if there is wetting and when this wetting occurs in relation to voiding. It will also allow us to better assess their stooling pattern and assure there is no constipation.
Most children will outgrow the symptoms of overactive bladder on their own without intervention, if there is no abnormality present. Your Nemours urologist may recommend some medications to relax the bladder depending on your preference and the age of your child.
Addressing your child’s symptoms of overactive bladder and wetting can dramatically improve your child’s quality of life. We often see children’s nighttime bedwetting improve after their daytime symptoms are addressed.
Creatinine is a waste product that the muscles produce at a steady rate as part of normal daily activity. The bloodstream carries creatinine to the kidneys, which filter it out of the blood, then creatinine passes out of the body in the urine (pee).
A urine creatinine test measures the amount of creatinine in the urine. It can be done on its own or with other tests that determine the amounts of other substances in the urine.
Why It's Done
Healthy kidneys filter the blood to rid it of waste products that the body can't use. Low levels of creatinine in the urine may point to a kidney disease, certain muscular and neuromuscular disorders, or a blockage in the urinary tract. If test results are abnormal, other tests will be done to make a specific diagnosis.
A creatinine clearance test measures how much creatinine is passed in the urine over several hours. A blood test to measure the creatinine level in the blood is also usually done. This gives doctors information about how well the kidneys are functioning.
A doctor may order a urine creatinine test in combination with other urine tests even when no kidney problem is suspected. Because creatinine is filtered out at a fairly steady rate, doctors compare the creatinine level with levels of other substances to see if they're excreted at a normal rate.
Your child might need to temporarily stop taking certain drugs that affect the urine's creatinine levels and might be asked to not eat large quantities of meat in the day or two before the test.
For a creatinine clearance test, you'll need to collect all the urine your child passes usually over 24 hours. If you are doing this at home, this usually involves first getting a special container from the lab in which to collect the urine, plus specific instructions.
If your child isn't potty trained and can't urinate into a cup, urine collection bags with adhesive tape on one end might instead be used to collect the samples. Your baby's genital area will need to be cleaned, and then the bag is placed around the urinary opening and secured with the attached tape. A diaper can be placed over the bag. The bag will need to be changed frequently to collect all of the urine, and each bag will need to be emptied into the special container.
Another option is the use of a catheter (a narrow, soft tube), which can be inserted into the bladder and left there for 24 hours to obtain urine.
If you collect the specimen at home, follow any storage and transportation instructions the lab gives you.
What to Expect
Because the test involves normal urination, there shouldn't be any discomfort as long as your child can provide a urine specimen.
Getting the Results
In general, the results of the urine creatinine test are available within a day or two. Your doctor will go over the results with you and explain what they mean. If abnormalities are found, further tests may be needed.
No risks are associated with taking a urine creatinine test.
Infants may occasionally have skin irritation from the adhesive tape on the collection bag. If a catheter is used to get the urine, it may cause temporary discomfort. If you have any questions or concerns about this procedure, talk to your doctor.
Helping Your Child
Explaining how the test will be conducted and why it's being done can help ease any fear. Make sure your child understands that there should be no foreign matter, such as toilet paper or hair, in the sample. And all the urine should be collected for the test to be accurate.
If You Have Questions
If you have questions about the urine creatinine test, speak with your doctor.
Reviewed by: Yamini Durani, MD
Date reviewed: September 26, 2016