Constipation and Soiling
Most children will pass a stool every 2 to 3 days without straining or discomfort. For constipation (encopresis) to be diagnosed in children aged over 4 years they must have two of the following symptoms;
- Two or less poo’s in the toilet/ nappy per week.
- At least 1 accident per week (if toilet trained)
- A history of holding postures.
- A history of very large or wide poo’s
- Poo that may obstruct the toilet.
Soiling can occur when rectum becomes overstretched and stool can pass without the child feeling it. This presents in most children around the ages of 7-8 years.
Bowel assessment and retraining will involve an individualised program of education, removing guilt and setting expectations for treatment. It may involve a bowel diary, abdominal palpation or real time ultrasound to assess the colon and rectum. Medications may be advised from your GP, age appropriate routine will be implemented, hygiene and skin care, advocacy for the child at school or care and referral to further specialists if needed.
Bedwetting occurs when bladder (over) filling does not wake the child or the bladder muscle contractions do not wake the child. It can be caused by a combination of an abnormal amount of urine production, deep sleepers not waking up, constipation and pressure on the bladder or urinary tract infections. Bedwetting is commonly NOT a result of drinking too much after dinner, behavioural issues, laziness, or being young for your age.
When to seek help?
- Wetting after being dry for some time
- Frequent wetting after school age.
- The wetting bothers the child or they want to fix the issue.
Day wetting in children can be caused by overactive bladder, bladder underactivity, poor bladder emptying or ignoring the urge to urinate. Children with overactive bladder may visit the toilet more than 8 times each day and have urgency with small volumes of urine. Some children visit the toilet less often but have leakage which may be from overfilling or urinary tract infections. There can be many causes of day wetting some may be simple such as a change in environment, routine or constipation and others more complex involving the nerves and individual anatomy.
Bladder and bowel control milestones are different in each individual child. Usually some control will start around the ages of 2 -3 years. Daytime control tends to be around ages 3-4 with nights following at ages 3.5 – 5 years. Picking the right time to starting toilet training can be difficult and some good signs to start would be
- Independently sitting on the potty.
- The child is not constipated.
- Daytime dry for 1 -2 hours.
- Can follow simple instructions.
A healthy bladder and bowel needs healthy food, lots of water (especially during this training time), exercise and a relaxed environment.