Does Your Child Wet His Pants During the Day?

An expert in pelvic floor dysfunction offers parents advice on the causes of bladder and bowel dysfunction in toddlers and children, plus tips on how to avoid and treat these conditions with proper diet and behavior changes.

From infancy through the toddler years, wetting and soiling diapers is a normal part of growth and development in children. In infants, the bowel and bladder fill and empty continuously. As the infant develops through the toddler phase a complex eliminating system matures. The average normal range for a child to gain full bowel and bladder control is age 5. By this time, all of the complicated connections between the brain, spinal cord, bowel, bladder, and muscles surrounding them, in most children, have matured enough to maintain continence and allow voiding when appropriate. Problems begin when children who have sufficiently surpassed this age continue to have difficulty with maintaining continence. 

Children beyond the toddler years may continue to experience urinary incontinence (wetting clothes) during the day and/or at night. They may also experience bowel incontinence and/or chronic constipation. These types of issues may lead to psychological distress in the affected child having to face social pressures and acceptance in school and community. Parents can be distressed while trying to find a way to help their child through such a difficult period. There is good news for many: These situations may be stemming from issues that can be relatively easy to address.

Some of the more common reasons a child may have difficulty staying clean and dry are:

1.  Improper diet and/or fluid intake

Frequently, children do not drink enough water nor eat enough fiber. In turn they become constipated. With chronic constipation, the bowel becomes distended with waste material and places undue pressure on the bladder, potentially leading to urinary leaking. Juices and soda that are consumed in excess are loaded with sugars and acid that can irritate the lining of the bladder, making a young bladder inflamed and sensitive. This too can lead to problems with frequent urination or urine loss. Lack of water intake can also concentrate urine, yet another way to irritate the bladder. 

2. Holding back urine or bowel movements when the urge is present due to being busy at play

Just about anyone who has a young child knows when she is busy at play, she can become distracted, wanting to continue the fun and ignore the signals her body is sending, thereby not announcing that she has to void. If this is done routinely, it becomes a habit. The body and brain learn different abnormal voiding patterns. The bladder is repeatedly taught to quiet down or ignore its signals, causing the bladder to distend excessively, leading to an uncontrollable loss of urine and a wet and distressed child. The urge to have a bowel movement may also be suppressed, thus leading to constipation.

As aforementioned, chronic constipation can in turn lead to urinary incontinence. In fact, one of the leading causes of urinary incontinence in children is chronic constipation. The internal pelvic muscles become weak and lack coordination. Pelvic floor muscles become too tense, too weak, and too uncoordinated to relax and contract appropriately in order to close off the openings (sphincters) of the bladder and bowel to allow the child to stay clean and dry. These muscles need also to relax correctly in order to allow the urine or stool to pass at the appropriate time, once the urge is recognized.

3. Stress reaction

Stressful life situations, including the shame that can come with being an incontinent child, can also stimulate the bladder and slow down the bowel, further exacerbating the problem. 

ACTION PLAN

If your child is having any of these problems after his or her toddler years, it is recommended you consult with your pediatrician to rule out any serious medical conditions.

It is important to be certain that he or she is getting adequate fluid intake, especially plenty of water. It is recommended that a child between the ages of 4-8 drink approximately five cups of water per day; with vigorous exercise and sports participation, more. This will keep your child hydrated, keep her urine from becoming too concentrated, and help soften hard stools. 

Be certain there are plenty of fresh vegetables and fruits as well as whole grains in her diet. This will allow good nutrient intake as well as bulking up and softening stools. Keep acidic and sugary drinks and foods to a minimum, perhaps limited to special occasions. 

At times, a bladder training program is necessary to train the pelvic muscles, bladder, and brain to conform to a new, more normal pattern of voiding behavior. According to the Centers for Disease Control and Prevention, it is presently recommended that 60 minutes each of aerobic activity, muscle strengthening, and bone strengthening exercises be performed at least several times per week. This provides a multitude of health benefits including good bladder and bowel health.

Being supportive of your child at this time is important in lowering stress levels. Talking with your child, explaining that she is not to blame, and that things can improve with your help along the way, will go far in building confidence.

Getting teachers and caregivers involved in your child’s health and healing is also important for consistency in care. Consulting with a physical therapist that specializes in treating pelvic floor muscle dysfunction can be extremely helpful in guiding a child together with a parent in proper training techniques to improve and resolve many of these types of issues. Physical therapy may consist of the use of biofeedback to retrain pelvic muscles, a bowel or bladder training program, exercise programs, and stretching programs. Following these guidelines may help your child lead a more healthy and happy childhood. 

Luba Starostiak, PT, OCS, is a Board Certified orthopedic specialist with a subspecialty in pelvic floor dysfunction. She has more than 20 years of clinical experience and is the founder of Lotus Physical Therapy in Pomona, Rockland County, NY and is also the mom of a 6-year-old daughter.

Also see:

What Should You Do About Bedwetting?

A Parents' Guide to Raising Healthy Kids