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The common wetting problem in girls is that of bladder instability. Often a girl will become continent at a young age, only to develop wetting six months later. The wetting might only make the young girl's nickers damp, or might be flooding episodes.  The classic story is of a girl who sits onto her foot during a bladder spasm that is not assoicated with a full bladder, occluding her urethra with her heel.  When she stands up, her mother will say, "go to the toilet", to which she responds, "I don't need to".  The solution is a combination of drinking more fluid, impoving the fibre in the girl's diet, having showers, not baths, washing carefully and going to the toilet proactively - every 2 hours.  Antibladder spasm medication also helps - the drugs often used is oxybutinin, otherwise known as ditropan, which helps to stop the spasm that causes the squatting onto the heel show in the pictures.PIC00006

Infections are often part of the problem, and often the focus of the treatment, because the infections are considered the primary, rather then the secondary condition.  Interestingly, often such girls will also wet at night, but not all of them do.     

An ultrasound of the renal tract and a voiding diary help to focus the patient on the solution, which often takes time for the girl to commit too, because of the lack of confidence in the ability to be dry.  Rarely, further investigation is required, which might include a nuclear medicine study of the kidneys and investigation of bladder with a cystogram (xray images), or a cystoscopy (looking into the bladder with a telescope, under an anaesthetic).  Dilatation of the urethra, while advocated by some, seems to play a limited role, and urodynamic studies (pressure/volume analysis) are usually not necessary. Understanding the problem, drinking adequate fluid and voiding reguarly make most of the difference.

Some girls will improve rapidly, once the phenomenon is explained to the family, others require a number of consultations before the bladder improves.
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