Dehydration may cause headaches, light-hot headedness, dizziness, lack of energy and make your child more grumpy than usual. It will also cause the wee (urine) to become more concentrated and darker yellow in colour. This is because the kidneys produce less wee as the body tries to hold onto water. Poos will also become drier and harder as the bowels hold onto water. This may cause constipation.

The bladder relies on regular emptying to help prevent urinary tract infections (UTI). If children are not drinking enough, they will wee less than the usual 5-7 times a day, and this may increase their risk of getting urinary tract infections.

Some children may limit their drinks, in the mistaken belief that they will not need to go to the toilet as often (particularly in school). However, the wall of the bladder is very sensitive and can become irritated by concentrated urine. If irritated, it will be less likely to hold on to the wee for a long time and may give the child less notice that they need the toilet. Families will often think their child is leaving going to the toilet until the last minute. They may also see their child ‘dancing,’ crouching, or holding their groin just before going to the toilet. Sometimes the child may end up needing to wee more than seven times a day, or they may get wet on the way to the toilet.

Not drinking very much or passing small amounts of wee frequently, because of bladder irritation or being sent to the toilet too often to try and prevent wetting, means that the bladder does not get an opportunity to stretch properly, so it may be smaller than usual. This can affect a child’s ability to achieve night time dryness as well.

Children who become constipated may also have problems with their bladder. This is because the end of the bowel (the rectum) is normally empty. The sensation of needing to have a poo happens as the poo moves into the rectum. If the signals are ignored for any reason, such as the child being unable to get to the toilet, or not wanting to go for any reason, the poo will stay in their rectum. If they continue to ignore the signals, they will become constipated. The poo that remains in the rectum takes up space that the bladder needs and puts pressure on the bladder, which then needs to be emptied at short notice and more frequently than is usual. If you think your child has a problem with constipation ask your child’s GP for advice.

Constipation may also be one of the causes of night time wetting for some children.  Another cause may be that the bladder is not able to hold as much wee as it should, something that can happen if a child is not drinking well during the day. More wee will be made at night if the child is drinking most of their drinks in the evening. This is one of the reasons why a good fluid intake, evenly spread out throughout the day is so important.

What should children be drinking?

Children (and adults) should be drinking enough water-based fluids that they do not feel thirsty. Children should be having a drink about every 1 ½ to 2 hours, until about an hour before bedtime. This is equivalent to six to eight drinks a day. The healthiest drink is water. The body uses milk as a food, so this is often not counted as part of the daily fluid intake. Fizzy drinks and drinks containing caffeine (tea, coffee, chocolate, cola and some energy drinks) can irritate the lining of the bladder and so make problems worse. They should be avoided.

Younger children need proportionally more water than older children, and older boys need more than older girls. Children who are overweight, who are in hot environments or who are very active need more as well. The recommended intakes of water-based drinks per day are:

• 1 – 3 year olds should have 900 – 1000mls
• 4 – 8 year olds should have 1000 – 1400mls
• 9 – 13 year old girls should have 1200 – 2100mls
• 9- 13 year old boys should have 1400 – 2300mls
• 14 – 18 year old girls should have 1400 – 2500mls
• 14 – 18 year old boys should have 2100 – 3200mls

During the school holidays it is easier to encourage children to drink. Reluctant children may drink more if allowed to chose their cup or glass, add ice cubes to their drinks, or play a game or read with their parents while drinking, or have dedicated drinking times with other family members.

How are children’s bladder problems treated?

Usually the first treatments tried in children with bladder problems are establishing good drinking and toileting routines. This is more difficult to do when children are at school, which is one reason why the summer holidays are a good time to work on bladder health.

What toileting routines help children’s bladder health?

Children with bladder problems should be encouraged to go straight to the toilet as soon as they feel the need to wee. They should also be asked to go to the toilet if their parents or carers notice them ‘dancing’, holding themselves or crouching. A good toileting routine would include them going for a wee about fifteen minutes after a drink, or about every two hours.

When children go for a wee they should be encouraged to relax and stay on the toilet until they are sure they have finished. Girls should sit with their bottom and feet well supported. Boys should stand and relax. They may find it helpful to sit to wee at least once a day, if they have any bladder problems. To poo both boys and girls should sit with their bottoms well supported, their feet flat on a firm surface and their knees higher than their hips. Most children will need a step under their feet to achieve this and many will need an insert seat.

In the summer holidays there is more time for children to get into a good routine of using the toilet, including having a regular time to poo. Children should also have open access to the toilet more often when they spend more time at home. They are not always able to have this at school.

What about treatments for bladder problems?

One of the most common bladder problems is bedwetting. In addition to good drinking and toileting routines during the day, going for a wee just before sleep and avoiding all drinks and food for an hour before going to bed are important. This can be easier to achieve in the summer holidays when there are fewer organised evening clubs and activities.

There are two main treatment options for bedwetting, either medication (usually desmopressin) or an alarm. Following an assessment your healthcare professional will decide with you and your child which would be the most suitable. The alarm is a device that makes a noise when the child starts to wee during sleep. The aim is to wake the child as they start to wet. Over time the child either learns to wake to the bladder signals and is therefore able to get up and go to the toilet, or they learn to sleep through the night, without needing to wee.

As the alarm is designed to wake the child, it will inevitably disturb their sleep. Getting up for school after disturbed nights is difficult. It is also harder to get up when the bedroom is cold, as happens in the winter. Therefore, summer holidays can be a good time to start using an enuresis alarm for children who have issues with bedwetting. It may take up to three months, or sometimes a bit longer, for an alarm to work fully. Therefore, by the time school restarts most children, where the alarm is likely to be successful, are already sleeping for longer before they wet and some may be having more dry nights by the time they have to go back to school.

Where can I go for further support and advice?

Although the summer holidays can be a good time to work on bladder health, by establishing good drinking and toileting routines and starting treatments such as enuresis alarms, families should not delay seeking support and advice if they have concerns at any time of the year.

If you are concerned about your child’s bladder health then discuss these with their GP, health visitor or school nurse. You may also contact the Bladder & Bowel UK helpline at bbuk@disabledliving.co.uk or telephone 0161 214 4591.

There is also lots of information about children’s bladder health and other conditions that affect children’s bladders and bowels on the Bladder & Bowel UK website at www.bbuk.org.uk

The post Improving children’s bladder health during the summer holidays appeared first on Bladder & Bowel UK.

1. FABLE: Your child will tell you when they are ready to toilet train

FACT: Some children will become increasingly aware of when they are doing a wee or a poo. At some point between the ages of two or three, these children will start to let their families know that they need their nappy changed, or even ask to wear washable pants. However, this happens much less often than it used to in the days when all children wore cloth nappies. In the 1960s and 70s most children were toilet trained by the time they reached their second birthday. Now most children are toilet trained at around the age of three years.

Disposable nappies are excellent at what they do: keeping a child’s bottom feeling dry and comfortable when they wee or poo. This allows the child to ignore the sensation of needing the toilet and carry on with what they are doing. They know that they will be changed when their full nappy is noticed.

The signs that many families are told to look for to know their child is ‘ready’ to toilet train do not work with disposable nappies. Things that are often relied on as signs, such as the child indicating they have done a wee or a poo, are not backed-up by research. There is not even agreement from professionals and experts about which of the ‘readiness signs’ are most important, or how many of them should be present.

Looking at it another way, why would a child instinctively want to change something that has worked for them since birth? This is even more true for children with additional needs, who may not understand the social expectation to use a toilet.

The nurses at Bladder & Bowel UK recommend starting to work on the skills for toilet training as your child approaches their second birthday and even earlier than this for children with known additional needs. These skills include learning words for wee and poo, learning to sit on the potty or toilet, recognising the bladder and bowel sensations and eventually getting wee and poo in the right place.

There is lots of information about how to approach toilet training at https://www.bbuk.org.uk/children-young-people/children-resources/

2. FABLE: Toilet training gets easier as your child gets older, particularly if they have additional needs

FACT: Learning how to use the toilet may take children with additional needs longer than their typically developing peers. However, leaving it later does not make the process quicker or more successful. Leaving toilet training until your child gets older may make it even more difficult. This is because your child has had more time learning that the place where they wee and poo is their nappy. It is harder to change habits that have been in place for longer.

There is evidence that early potty training helps the bladder mature. This can prevent problems with the bladder later in childhood. Also, there is a cost saving to families once children are toilet trained: there is no need to buy nappies. It is also better for the environment as nappies are made from oil-based products and end up in landfill.

At Bladder & Bowel UK, we recommend that all children should be supported to start learning the skills for toilet training before they reach their second birthday and by about eighteen months of age for children with additional needs. In this way the toilet training process becomes a normal part of their day.  For children with additional needs the step-by-step approach to toilet training works particularly well. There is information about this in the Bladder & Bowel UK leaflet ‘Toilet training children with special needs’ at: https://www.bbuk.org.uk/wp-content/uploads/2018/03/Information-sheet-re-Toilet-training-children-with-additional-needs.pdf

Bladder & Bowel UK have joined forces with Positive About Down Syndrome to create two closed Facebook pages to support families of children with Down syndrome in the UK to toilet train their children. These are: ‘DSUK Going POTTY?! Toilet training advice & tips 4 children with Down syndrome’ and ‘DSUK Toileting issues 4 children & young people with Down syndrome aged 5+’

3. FABLE: If your child is having problems with wetting it is because they are drinking too much

FACT: The human body is mainly water, so needs us to drink well every day to stay healthy. If children do not drink enough water-based fluids, they are more likely to become constipated. This is because the bowel will take extra water out of our poos, so the poos become hard. Having hard poos stuck in the lower bowel, gives the bladder less space. This can upset the bladder and make it twitchy, which results in wetting.

When humans do not drink enough water their wee becomes stronger (darker yellow). This can upset the lining of the bladder and may also cause bladder twitching which results in wetting.

A good fluid intake keeps poos soft and prevents constipation. It also helps the kidneys to make a greater quantity of wee that is more dilute (pale yellow). Therefore, the bladder is not irritated and gets more exercise, so learns to work better. Regular drinks (about every two hours until an hour before bedtime), followed by regular toilet visits after each drink, can prevent wetting.

Wetting is not caused by drinking too much. However, it can be caused by not drinking enough water-based fluids. Wetting can also be made worse by drinking the wrong things. Fizzy drinks and drinks that contain caffeine (tea, coffee, hot chocolate, cola and many energy drinks) can all make wetting worse. How much children should drink varies according to age.

Suggested intake of water-based drinks per 24 hours by age and sex

(Adapted from CG 111 Nocturnal Enuresis NICE 2010 and American dietary requirements, cited in CG 99 Constipation in Children and Young People, NICE 2010)

For more information on daytime wetting see the Bladder & Bowel UK leaflet ‘Talk About Daytime Bladder Problems’ at https://www.bbuk.org.uk/wp-content/uploads/2018/12/Talk-about-Day-Time-Bladder-Problems.pdf

4. FABLE: Children who get wee or poo in their pants are lazy and/or naughty

FACT: Children are not naturally lazy. They are energetic and love to learn about things that interest them. Children are also not deliberately naughty. They may do things adults do not like, because they have different priorities, or do not understand how things should be done, or are trying to solve a problem the only way they know how.

Children who get wee or poo in their pants nearly always have a bladder or bowel condition. Constipation, which is not always easy to diagnose in children, is nearly always the cause of poo accidents and can be the cause of wetting as well. Bladder twitching can cause children to do the ‘wee dance’, hold their groin, or crouch with their heel against their bottom. Others will appear to run to the toilet at the last minute, or even too late. This is an automatic response to the bladder twitching suddenly and unexpectedly and is not the child being lazy or naughty. Children who wet the bed when they are asleep may only do so on some nights. Again, this is not their fault but is as the result of a bladder and/or bowel problem.

Wetting and soiling (pooing in the pants) are very common in childhood but are not often spoken about. For this reason, many families feel alone. If you are concerned, speak to your child’s health visitor, school nurse or contact the Bladder & Bowel UK helpline at email bbuk@disabledliving/co.uk or telephone 0161 214 4591.

5. FABLE: Bedwetting is caused by children sleeping too deeply

FACT: Bedwetting is caused by children either making more wee during the night than their bladder can hold, or their bladder not working as well as it should while they are asleep. Children who wet the bed are unable to wake fully to the bladder signals, which is why their bladder lets go.

Children who wet the bed often sleep less well than their peers. This is because the bladder signalling that it needs to empty during the night disturbs their sleep, it just does not fully wake the child. This may leave children who have bedwetting more tired the next day and therefore even less able to wake the following night.

An assessment and treatment should be offered to children who have ongoing bedwetting after their fifth birthday. Your child’s health visitor, school nurse or GP should be able to offer some initial suggestions and if these do not help, they should be able to offer treatment or refer your child to a specialist clinic.

There is more information about bedwetting available in the Bladder & Bowel UK leaflet ‘Talk About Bedwetting’ at https://www.bbuk.org.uk/wp-content/uploads/2018/09/Talk-about-bedwetting.pdf

6. FABLE: Laxatives make the bowel lazy

FACT: Constipation can affect up to one-third of children at any time. For about one in three of these, the constipation will continue and become chronic, that is it will last for more than a month.

If constipation continues, it often gets worse as larger amounts of poo get stuck in the child’s lower bowel. The large poos stretch the muscles that line the bowel, so that they become less able to do their job of moving poo towards the bottom.

Laxatives (medicines to help treat constipation) help to clear out any poo that has become stuck inside the bowel. However, if they are stopped too soon the stretched bowel muscles will not have had a chance to recover. Because they are still over-stretched, they are not good at pushing the poo to the bottom, so the poo starts to build up again. This may make it seem as if the laxatives have made the bowel lazy when it is actually that they have not been given for long enough.

It is important to treat constipation with laxatives as soon as you notice a problem with your child. The laxatives should be continued for as long as necessary and only stopped gradually.

There is more information about constipation in the Bladder & Bowel UK leaflet ‘Understanding Childhood Constipation’ at https://www.bbuk.org.uk/wp-content/uploads/2017/11/Understanding-childhood-constipation-leaflet-advice-for-parents-and-carers.pdf

To see the full range of Bladder & Bowel UK’s information leaflets for children and families visit https://www.bbuk.org.uk/children-young-people/children-resources/

For more information and advice speak to your healthcare professional and always follow their advice. You may also contact the Bladder & Bowel UK confidential helpline at email bbuk@disabledliving.co.uk or telephone 0161 214 4591.

The post Children’s bladder and bowel issues: Some fables and facts appeared first on Bladder & Bowel UK.