Posted tagged ‘bedwetting’

A crisis for our bladders

January 30, 2012

The Pediatric Insider

© 2012 Roy Benaroch, MD

OK, listen up, people: you have to pee, at least every once in a while.

I know, I know. In elementary school, your teacher won’t let you leave class. In middle school, there isn’t enough time between classes. And in high school, well, I guess the thinking is one wouldn’t be caught dead using a toilet or something.

What happens if you don’t empty your bladder? To put in simply, Mr. Bladder doesn’t like staying full all day. Like any other muscle, if you keep it under stress it will get thick and bulky—and that’s a problem for bladders. Thick, bulky bladders can’t empty well. They squeeze too hard, and pinch off the tube that leads out. So when you finally do try to pee, you’ll get maybe just a little out. Not emptying your bladder isn’t good.

I see kids of every age in my office, every week, with these kinds of bladder issues. Running to the bathroom at the last minute, having little accidents (sometimes with laughter or coughing), pain with urination, or a feeling that you have to urinate very frequently—all of these symptoms are most often caused by a habit of not urinating frequently or completely enough. Sometimes, recurring urinary tract infections can happen, too. If you’re in the habit of holding it like a camel, you’re heading for trouble. There’s even a medical name for this: “dysfunctional voiding syndrome.”

So what should you do if you or your child is having these symptoms? Most importantly, make sure there’s unhurried time for complete bladder emptying at least every couple of hours. Don’t rush! Little kids might need something to distract them to slow them down, like a special video game that’s only played on the potty. Older children need to change their mindset: you don’t urinate just long enough to relieve the pressure. You should urinate until you’re completely done—and, to help make sure, you should probably relax and try to urinate again after you think you’re done the first time.

Schools and teachers need to rethink policies that don’t allow kids private, relaxed time to take care of their business. Four minutes between classes wouldn’t be enough time for even The Flash to get to his locker, run though the building to the one clean bathroom with working sinks, and then get back to class. Policies that keep kids squirming in their seats with their legs crossed are idiotic and unhealthy.

Make your bladder gladder. Take time to pee. Your bladder will thank you!

Accidents happen

May 20, 2010

The Pediatric Insider

© 2010 Roy Benaroch, MD

From Jennifer: “My daughter will be 6 in a week and is in kindergarten at a public school. She has accidents quite frequently at school and on occasion, they are poo accidents. In the past, she has waited too long to go and that is when the accidents happen. I don’t feel comfortable disciplining her because I don’t think she is doing it on purpose. But I did talk to her about how she is almost 6 and should try to not have accidents. That seemed to have stressed her though because when she came home yesterday after having an accident, she told my husband that she was a failure and couldn’t be 6. It broke my heart. I’m just at a loss. Telling her to go potty even if she doesn’t feel like she has to go is confusing for her to understand. Is it possible that she doesn’t ‘feel’ the need until it’s urgent? If so, how long does that last?”

First, let me assure you that this is a very common problem, and that it’s very unlikely that there’s anything really wrong with your daughter, either psychologically or physically. Kids are kids, and they get caught up playing, and they really don’t like to stop what they’re doing to take care of business. Accidents like these don’t happen because a child is being defiant, or willful, or even purposeful.

There are some rare “red flags” that could indicate a medical issue. A child who has a big change in habits suddenly should be evaluated at the doctor’s office, as should a child whose accidents are accompanied by painful urination, fever, or blood in the stool. Even these kids are unlikely to have a serious medical condition, but still, the physician should look.

Jennifer said, “Telling her to go potty even if she doesn’t feel like she has to go is confusing for her to understand.” That might be true, but you and the teacher still ought to do it. Don’t ask– she’ll say no– and don’t suggest it, either:

  • Don’t: “Do you have to use the potty?”
  • Don’t: “I think it’s time to use the potty.”
  • Don’t: “You really ought to use the potty.”
  • Do: “Time for everyone to stop what they’re doing for a potty break.”

She shouldn’t be singled out, and it should be clear that all fun/activity stops during the break, to resume afterwards. Do this at home, too, and include yourself:

  • Do: “You know what? It’s time for you and me to take a potty break”

It can help to use a kitchen timer, so it’s not your fault that that potty time is here. You can set it to go off every few hours, or just set it to go off in 5 minutes when she isn’t looking. Nothing wrong with a sneaky trick!

“Is it possible that she doesn’t ‘feel’ the need until it’s urgent? If so, how long does that last?”

Yes, in fact it’s very likely. If she’s used to holding her stool and urine, she’s gotten used to the feeling of a full bladder and rectum. She’ll become less sensitive to her body’s own signals to tell her when she’s full. If you help her remember to keep herself empty most of the time, these sensations will soon return to normal– though it will take weeks or even a few months, not days. New habits can be learned, but sometimes not as quickly as you’d like. I don’t think this is going to be a quick fix.

If your daughter has firm or large stools, it’s very important that you treat the constipation. You ought to work with your child’s pediatrician for instructions and ongoing follow-up for these problems. You can also find more details about the treatment of urinary frequency and accidents are here.

Five year old with a wet bed

May 20, 2008

Kelly asked if she should do anything about a 5 year old chlid who is still wetting the bed.

Night training will occur automatically, and there really isn’t anything parents can do that makes much difference. Think about it: the kiddo’s asleep, and isn’t really trying or not trying to do anything. Star charts, rewards, punishments, or “practice” are all very unlikely to make any difference.