Potty-training is fun, said no one ever.
Arguably some of the most frustrating and expensive parts of raising a child stem from the potty-training process. The trick to potty-training is waiting on the readiness of the child, and it’s important, for your own sanity, to remember that this can occur anywhere from two to four years of age. Keep at it, but the decision on when to start potty training is ultimately up to your child.
Fast forward to year eight and your perfect kiddo that was fully potty-trained at age three is now wetting their pants again. What?! No one told me this would happen! If potty-training was difficult before, this is a whole other beast. The reality of this set-back is now obvious to not only you but also to your child and their observant classmates and friends.
Why is my child wetting their pants?
While there are a handful of reasons why your child might be wetting their pants again, there are several behavioral changes that will help in a lot of cases. These changes revolve around urinary holding, constipation, overactive bladder, and vaginal voiding (urinating).
One of the number one causes of urinary accidents is holding urine in for too long. Kids like to play and learn at school, and bathroom time is of much lower priority than Play-Doh, recess, or story-time. The trouble is that their bladder is constantly filling, whether they go to the bathroom or not. There comes a point in which the bladder becomes overwhelmed and a urinary accident will occur. The bigger problem here is that if your child is not emptying the bladder frequently enough, the bladder muscle can become too thick and strong. When that happens, the bladder no longer does a great job at keeping the urine in when a contraction sets in.
Hold on to your hat here, because we’re going to break all etiquette and talk about poop. No one said potty-training was going to be easy, fun, or clean. Second to urinary holding, constipation is a huge player in urinary incontinence. The rectum is a part of the body that holds stool prior to a bowel movement. This sits right behind the bladder. As you can probably imagine, if there is a large burden of stool or hardened stool in the rectum, this can push up against the wall of the bladder. The bladder wall then becomes irritated and contracts, and a urinary accident occurs.
Overactive bladder is the case in which the bladder muscle is on overdrive. In most cases, urinary holding and constipation lead to bladder overactivity. There are some cases in which the bladder is overactive for no reason, and you should talk to your medical provider about medications to calm the bladder down.
Vaginal voiding is a special type of urinary incontinence that happens only in female patients. In this case, a small amount of urine passes back into the vaginal opening instead of down into the toilet. When this occurs, the female patient will urinate, and sure enough, have a small accident within seconds to minutes of changing positions to stand and walk out of the bathroom.
what can we do to help keep our kids dry?
Make a routine
First and foremost, we need to practice timed voiding. This means that your child must have a routine of going to the bathroom. We recommend toileting every two hours while awake. The key here is that your child needs to go to the bathroom to try, whether or not they feel the urge to go, on a schedule throughout the day.
Potty charts and other incentives also work really well here. If your child is like most, your incentive may change frequently. The goal is to relieve the bladder before the irritation sets in.
Help prevent constipation
Second step is to avoid constipation at all costs! The goal is to have at least one soft bowel movement daily. Some specialists say that you can even practice timed stooling. The greatest chance of having a bowel movement is 15-20 minutes after eating, so having a potty break after meals is an important step. There are ways to prevent constipation, and those may include daily Miralax, increased water, physical activity, and fiber supplementation. They even make fiber gummies. What kid doesn’t like gummies? Talk to your medical provider about dosing of any medications, including those over-the-counter.
Adjust their position on the toilet
If you suspect you have a vaginal voider on your hands, there are position changes while urinating that will help immensely. It’s not often that we find toilets that are the right size for our little ones. I think everyone can picture their tiny tot holding on for dear life while going to the bathroom. Most toilets are huge! The goal here is to have the feet flat on the ground. You may have to use a step stool under the feet for this. You want the child to sit with knees spread apart and leaning just slightly forward. When done with urination, the child should rock back and forth a few times to get rid of those last drops. Another trick is actually having the child sit backward on the toilet. This does take monitoring by an adult to keep the child safe.
All children should remain on the toilet for one to two minutes after urinating and take deep breaths. This allows for the muscles in the pelvis to relax and empty any last bits of urine.
Wetting can lead to long-term medical issues
There is no question about the emotional effects incontinence can have on children and their families. It’s equally important to understand that wetting can lead to long-term medical issues as well. Urinary holding and constant moisture can lead to skin irritation, skin infections, and urinary tract infections. Recurring urinary tract infections can lead to high blood pressure, kidney damage, and impaired growth and development of the kidneys. This is a big deal!
Don’t forget there can be other medical reasons for urinary incontinence. If you feel that you have made these behavioral changes consistently and are not seeing results, it’s important to have this further investigated by your child’s pediatrician or health care provider.
The expert family medicine providers at the Des Moines University Clinic can help you start a potty training routine or treat effects of urinary incontinence. For more information or to make an appointment, visit the DMU Clinic website or call 515-271-1710.