Home Potty Training

A neurologically intact child (normal spinal cord and brain) can always feel when they need to go to the bathroom. Unfortunately, the longer a child delays going to the bathroom (for example, if he/she always empties their bladder at the very last minute, over a long period of time), the more muscular, powerful, and irritable the bladder gets. What that means is that the urge to urinate will come on very suddenly, and with great force, so that many children have to quickly squat to hold their urine, and can’t get to the bathroom without wetting. These children need to be placed on medicine to relax the bladder, as well as a timed voiding schedule, so they do not wait too long to empty.

Many parents of children with voiding dysfunction notice that their children seem not to mind when they have wet themselves, or don’t even notice that they are wet until the parents mention it to them.

Again, a neurologically intact child can always feel when they are wet, we just have to remember that children think differently than we do, and they may not care that they are wet, or not want to mention it for fear of being punished. This does not mean that the child cannot feel the need or urge to urinate, or is unaware when they urinate, and this reiterates the point that a child’s voiding schedule should not be left up to the child, but be coordinated with a schedule, so that the child knows they need to empty their bladder at regular intervals.

Some girls may wet themselves unknowingly during the day if they happen to urinate with their legs close together and urine accumulates in the vagina. This urine can then slowly drip out when they are upright and playing, and cause dampness with no sensation of voiding.

This is most likely due to the child not emptying their bladder completely. It is very difficult to know when a child has emptied their bladder, so we have to simply take their word for it. Urologists have found that voiding dysfunction is closely associated with Attention Deficit Hyperactivity Disorder. As you may guess, going to the bathroom is of no particular interest to a child, and is at best seen as a necessary inconvenience. Therefore, they often spend as little time as possible emptying their bladder, resulting in many instances where they leave their bladder rather full. Since there is no easy way at home to measure the urine left in a child’s bladder when they are done voiding, the best strategy is to use techniques to encourage the child to empty completely.

These strategies include using a urine hat (collection device) to measure the amount of urine voided (and then comparing the volume to the expected bladder capacity – which you can calculate), and using games to preoccupy the child while they are voiding so that they spend a longer time emptying their bladder.

One common example is to place Cheerios® in the toilet and have the child try to “sink” them while they void. The common theme is to try to prolong the time the child spends trying to empty. This can also be accomplished by having the child “double void” or attempt to empty again once they have stated that they are done. Positive reinforcement, or rewards, for extra emptying can help encourage this practice. It is also important that the child be able to sit comfortably to void, with their feet resting on the floor or a stool, and with all their pelvis muscles relaxed, so that they don’t limit their ability to empty.

Fecal soiling, or what physicians call “encopresis” is the result of a child attempting to delay emptying their bowels, and is associated with constipation. This problem can be treated by treating constipation, and by making sure the child attempts to have a bowel movement after breakfast and dinner every day.

A urinary tract infection (UTI) is a bacterial infection of any part of the urinary tract, which includes the kidneys and bladder. Unlike other areas of the body, such as the skin and mouth, the urinary tract should be sterile. A UTI, which requires antibiotic therapy, is diagnosed when bacteria are found in the urine, especially in association with symptoms such as frequent and/or painful urination.

UTIs are very common, affecting 8.4 percent of girls and 1.7 percent of boys by the age of 7. Symptoms can include fever, frequent and/or painful urination, and sudden problems with incontinence or having to rush to get to the bathroom on time.

All UTIs are caused by bacteria outside of the bladder traveling into the bladder via the urethra (the tube you urinate out of). It is normal to have bacteria in the area around the urethra, but not everyone gets UTIs. There are several factors for developing the infections. First, girls are more prone to UTIs because they have a shorter urethra than boys and because it can be harder for girls to keep the area around their urethra clean. Antibiotic therapy is another risk factor. When a child is treated for an infection with antibiotics, such as for an ear infection, the antibiotics often wipe out beneficial bacteria around the urethra as well, which allows more dangerous bacteria to grow into the area and often into the bladder.

Probably the biggest risk factor for UTIs in children is what is called “voiding dysfunction.” When children are toilet trained, they learn to hold their urine and/or stools and often put off urinating and/or passing bowel movements until the last possible moment, which is called “holding.” One of the body’s defense mechanisms against infections is the regular flow of the urine out of the bladder. However, if a child continually fights the urge to void, there is less of this urine flow to prevent bacteria from accessing the urethra.

Some children may also have an anatomic problem in their urinary tract (such as reflux or obstruction) that makes them more susceptible to UTIs, so any child with a history of a UTI needs an evaluation by a pediatric urologist.

Active UTIs are treated with antibiotics for 3 to 10 days, depending on the severity. Some children need to stay on a low dose of antibiotics for a short while to break the cycle of frequently recurring infections.

Children with voiding dysfunction may require medicines to relax their bladder (so they have less urgency, and can make it to the bathroom on time) or medicines to relax their bladder neck (so they empty their bladder to completion when they do void). All children with recurrent infections should be placed on a timed schedule of emptying their bladder every 2 hours while awake.

If there is a congenital, anatomic abnormality causing the infections, then this anomaly can often be repaired with surgery.

There are several myths regarding the causes of UTIs. For example, there is no good data that the method of wiping in girls has any significant impact on the incidence of UTIs. Of course, it is probably a good habit to have girls wipe front to back, but improper wiping is not a major cause of UTIs. Also, tub bathing, bubble baths, and/or swimming in pools cannot directly cause UTIs. Drinking sodas, or other drinks such as juices, also cannot cause UTIs in children.

There is some evidence that cranberry juice can help prevent UTIs in adults, but little support for its use in children. There is also NO evidence that cranberry juice can treat an active UTI infection.