As the end of the year approaches many young children will have their prep or kinder orientation before they begin school at the start of next year. This can be a nervous time for everyone involved, and even more so if your child struggles with toilet training.

It is also important to remember that if your child does struggle with bladder or bowel accidents, they are rarely attention seeking behaviour or laziness, it may be a medical issue that can be resolved with the help of medical professionals

There are a few different kinds on incontinence that your child may face. These include bedwetting, daytime wetting, constipation, and faecal incontinence. These all fall under the umbrella term, paediatric incontinence.

Bedwetting

Bedwetting, also referred to as nocturnal enuresis, is a common when children are beginning to learn how to control their bladder overnight. On average most children start not needing overnight nappies around 3 – 5 years old.

If your child is wetting the bed overnight, it is important to reassure them that they are not the only ones. Nearly a third of all four-year-old’s wet the bed.  For older children, this number reduces to 1 in 10 of six year old’s and 1 in 20 of 8 year old’s.

Some of the causes for bedwetting include bladder instability or over activity, difficulty waking up to a full bladder, increased night-time urine production, and constipation.

Daytime wetting

Daytime wetting is less talked about than bedwetting, but it is still a very common. As most children are dry by 3 ½years of age, starting kinder can prompt a parent to seek help.

There are many causes of daytime wetting.  There is a strong link to constipation with increased pressure on the bladder. Other factors may be related to an overactive bladder or under-active bladder, bladder habits or pelvic floor overactivity.  It may also be a symptom of another medical problem. 

Constipation

Constipation is when ‘poo’ is difficult to pass and less frequent. A 4 year old child should open their bowels 1-2 x day. Your child may have hard and dry poo that appears like rabbit droppings or poo that is very large. Other signs of constipation may include tummy pains, cramping, straining, spending a long time on the toilet or withholding movements. Soiling on the underwear may also indicate constipation. 

Childhood constipation can have a wide range of causes including toilet avoidance due to painful poos or anxiety around toilets, a child being too distracted and diet & fluid intake. Constipation may also be an indicator of another medical condition.

Some symptoms to look out for if you suspect that your child is dealing with constipation include stomach cramps, toilet avoidance behaviours such as hiding, wriggling, or stiffening and arching of the back, picky eating, or poor appetite, an anal fissure, infrequent and/or painful bowel movements and abdominal bloating.

Faecal Incontinence

Faecal incontinence is the involuntarily loss of a stool in the underwear when a child is over the age of 4 years. There may be skid marks on the underwear or a formed poo. Soiling on the underwear may also indicate constipation.  Liquid stool may then leak around the hardened stool.  The child is often unaware of the accident.

The use of Paediatric Continence Physiotherapy can assist in bladder and bowel control in children. In conjunction with your GP, BWC’s Physiotherapist Belinda Matthews will work with you and your child by taking a thorough history, assessing using non-invasive real time ultrasound, uroflowmetry and bladder and bowel diaries. A treatment plan is then developed helping to resolve constipation, faecal or urinary incontinence.

For an appointment with Belinda Matthews, please call Ballarat Women’s Clinic on (03) 5332 9940.

Written by Physiotherapist Belinda Matthews