Continence Support

We all appreciate that continence issues can cause a great deal of anxiety for both parents and children, but don’t worry, you’re not alone. There’s a number of tried and tested techniques you can use to get on track and we’re here to help. You might be surprised to learn that around 28% of children experience continence problems, so what exactly do we mean by continence?

Quite simply, continence is the ability to control your bladder and bowels. Your bladder is basically a muscular sac, a bit like a crumpled bag and like any other muscle you need to train and strengthen it to get it working properly by regular fluid intake and toileting.

When the bladder is full, it sends a signal to the brain to tell us to empty it, basically going for a wee to help keep our bladder strong and healthy we need to drink regularly and wee regularly.

It’s really to empty the bladder fully so make sure your child doesn’t rush going to the toilet and empties their bladder completely. We’re all different and the amount our bladder can hold differs too.

A typical 7 year old child’s bladder can hold about 240 millilitres, about the size of a small cup. The bladder usually matures at around 2 to 3 years of age and a child can become dry.

Going for a wee about 6 to 8 times a day is a good guide, and drinking around 6 to 8 water-based drinks will help keep the bladder healthy. Just bear in mind that your urine should be a pale yellow colour.

Caffeinated drinks, for example, tea, coffee, hot chocolate, energy drinks, cola and fizzy drinks should be avoided as they can contribute to bladder overactivity. Milk is healthy but is used by the body as a food, it should not be encouraged instead of or as part of total water based drinks.

If your child is wet during the daytime, a good first step is to get them checked out by your GP, just to make sure that there are no underlying medical issues. Believe it or not, one of the main reasons for wetting is not drinking enough and ignoring the signal to go for a wee. When we drink our bladder fills and sends a message to our brain ‘I need to empty’. The brain then sends a message telling us to go to the toilet. It’s this process that’s repeated at least 6 to 8 times a day which help increase how much the bladder can hold and also strengthens the bladder as well as increasing the strength of the signal from the bladder to the brain, telling us we need to wee.

As parents, we all know that children can get really engrossed in things and also be easily distracted. Sometimes they get so engrossed that they ignore the signal from their brains telling them to wee. Keep an eye out for the tell-tale signs that your child needs the toilet like, hopping up and down, rocking from side to side. This is all very well when they’re with you, but when they’re in school it can be a bit trickier.

There are a number of reasons why children don’t go to the toilet at school, but if they don’t wee regularly, the bladder just becomes stretched by not strengthened and this can causes problems. Some children may have an irritable bladder, this is when the bladder signals it needs to empty before it’s full. You might notice your child going to the toilet in a hurry many times a day. Another cause of wetting can be UTI’s or urinary tract infections. Look out for signs of this and be sure to see your GP to get it checked out. Constipation can also be a factor as full bowels can cause pressure on the bladder which may lead to wetting.

Anxiety and stress can also be a possible cause so it’s a really good idea to sit down with your child and talk about things in an open and straightforward manner. Your child can start by emphasizing all the positive things they can do that other children might not be able to do. This helps them understand that children develop at different speeds and one child might be quick to catch on to one thing but slower with something else.

This is a good time to remind your child to drink regularly and go for a wee as soon as they feel the urge. Maybe the use of a reward system could help here to get them to remember.

So what can we do about it if you think constipation or a UTI may be the issue, then make sure you contact your GP if you think your child has an overactive bladder, then again contact your GP.

Remember to make sure your child has enough water-based drinks throughout the day increasing them gradually as they ideally should be drinking 6 to 8 drinks. There’s a few ways you can vary your child’s drinks to keep them motivated. Don’t be afraid to mix things up and keep it interesting.

To help things along at school, fill their water bottle before they go and suggest times during the day they could have a drink. If your child isn’t drinking enough, a good way to check how they’re doing is to put a line on the water bottle about a quarter of the way down, maybe with some tape, and encourage them to drink to the mark. You can then move the mark down gradually, encouraging them to drink more.

So how much should your child be drinking during the day I hear you ask. Well here’s a chart to show you, and this is what a thousand millilitres looks like.

Finally here’s some top toilet tips to help you out.

• Ensure that smaller children have an insert seat and stool so they’re able to sit comfortably, well-supported and with their feet on a firm surface.
• When your child is on the toilet, once they’ve had a wee, get them to count to 10 and try again. Encourage boys to occasionally sit to wee as sometimes this can help empty the bladder.
• Alarm reminders can help – try setting them on your watch or on your phone
• If you see your child holding on rather than saying ‘do you need the toilet’, say ‘you need to go to the toilet now please’.
• You can make things easy for them by making sure they wear clothing that’s easy to get off to go to the toilet.
• Remember most important of all – try and stay calm and not worry too much – your child can pick up on any anxious signs you give and this may hinder their progress.
• Remember you child isn’t doing this on purpose and together you can work through this and get it sorted.

The reasons for children wetting the bed are still not perfectly clear and could be down to a number of things. It’s not necessarily down to poor toilet training, sometimes it’s simply a case of immaturity and the child will grow out of it. In the case of older children, the reasons may be more complex and further help may be needed.

It affects approximately 20% of five year olds and 10% of 7 year olds.

As with daytime wetting, not drinking enough of the right types of fluids may be a cause. Genetic factors may also come into play, it might simply run in the family.

Some children lack the hormone vasopressin which slows the production of urine at night. Your GP can prescribe medication for this if you feel this is appropriate for your child.

There are a few indicators for this,

• Wetting every night
• Wetting in the earlier part of the night

Again, as with daytime wetting, constipation may be an issue as the enlarged bowel puts pressure on the bladder.

Urinary tract infections (UTI’s) may also be a factor particularly if your child was previously dry. Anxiety and stress may be the reason, look out for any issues around major life changes as well as smaller everyday things such as exams in school, fall outs with friends, even excitement about and event or party.

Be sure to offer reassurance to your child.

So what can you do about it?

Well the first thing you can do is to make sure that that any issues with daytime wetting and constipation are sorted out first.

Don’t forget the regular fluid intake during the day – 6 to eight water based drinks is ideal.

And important step is to build in what’s known as double voiding – making sure your child goes to the toilet as part of their bedtime routine and then again just before they go to sleep, to make sure the bladder is empty.

You can also think about making things easy and safe for your child to go to the toilet during the night with the use of night lights if possible.

It’s not advisable to lift and carry your child to the toilet while they’re sleeping as this may encourage them to wee when they’re not fully awake.

Remember, you’re trying to strengthen the signal from the bladder to the brain.

Also don’t be tempted to put your child in your warm bed while you change their bedding – get them to help you so they realise they need to be part of the solution. This can be really stressful for you as a parent, especially being woken in the middle of the night, but try to stay calm and remember, your child isn’t doing this on purpose. Try to be as encouraging as possible.

If your child is wearing pull ups or night pants, only use them for sleep. Once they are dry in the day, day drinking the recommended amount and going to the toilet regularly, you can try removing the pull-ups.

Suggest sleeping without pull-ups for at least two nights, make sure the bed is well protected as accidents can still happen. Waking in a wet bed can raise awareness and prompt some children to be dry, but for others it might make no difference and make your child feel worse.

It’s best not to go in and out of pull-ups as this can be confusing for your child. Decide what’s best for you at the moment. It’s okay if your child is less stressed and wearing pull-ups for the time being, but discuss and help them to understand why they’re wetting and offer suggestions they could follow to get dry.

An alarm could help your child’s brain recognise the signals coming from the bladder when they are asleep, as soon as your child starts to wet the bed the alarm will go off.

After a while their brain will learn to respond to their bladder signal before the alarm goes off. Your child must be old enough to understand about the alarm and be motivated to want to be dry. It takes time for a bedwetting alarm to work, children need to get used to waking up and responding to it which takes time.

Remember to be patient and give lots of praise.

What do we mean by constipation?

 Very simply, it’s the inability to do a poo regularly or completely empty the bowel. It can happen to anyone, at any age. Signs of constipation might be a bit confusing. The poo might be small and hard or very large. Your child may withhold or strain. Your child may also experience soiling or overflow – that means loose stools.

So what happens to all that stuff we eat?

Let’s follow the food as it goes through our body. Down it goes through the oesophagus and into the stomach, from there it goes into the small intestine and then the large intestine. The intestines work hard to absorb all the goodness from the food, leaving behind the waste, better known to you and me as poo. The poo then moves into the rectum which is the lowest part of the bowel.

Some clever stuff then starts to happen as the nerves of the rectum stretch, sending a signal to the brain to tell us it’s time to do a poo. If we don’t act on the signal then, the nerves stay stretched but stop sending the signal to the brain. If this happens to your child then they no longer know that they need to poo, this is where the problems start. The longer the poo stays in the intestine, the more fluid is absorbed and the poo becomes harder and drier and bigger. This constipation can mean your child might feel bloated and have a painful abdomen, meanwhile stuff is still making it’s way through and sometimes liquid can find its way around the blockage and seep into pants, making you think your child has diarrhoea, when in fact they are just constipated.

Now here’s an interesting chart to share with your friends. It’s the Bristol Stool chart and shows the different types of poo – can you guess which is the best type?

Well number 4 is the magic number here, that’s the healthy type we’re looking for.

Again the best advice here is to see your GP to discuss medication and a regime to manage your child’s constipation. So what can we do to prevent constipation.

Well, healthy exercise always keeps things moving nicely and as ever, watching what we eat is really important. Just the usual stuff, plenty of fruit and veg, and food with a high fibre content like porridge, Weetabix or wholemeal pasta, again keeping those drinks coming. Don’t forget the 6 to 8 drinks a day, not too much milk though – two cups a day is plenty.

A healthy toilet routine is vital to keep everything in order on the bowel front.

The best time to go is about 20 to 30 minutes after a meal, this makes the most of the natural squeezing that happens after eating, so encourage your child to sit on the toilet at the same times each day. Use of a reward chart for sitting even if they don’t do a poo, can help encourage your child.

How your child sits on the toilet is also really important, they need to be relaxed and comfortable. Think about a stool for their feet as this gets the knees higher than the hips, making it easier to poo. There’s a few tricks to get your child to relax on the toilet if they find it difficult. Laughing and blowing are great so don’t be afraid to turn it into a bit of fun with party blowers or bubbles to get the tummy muscles working.

So remember, try not to worry, be patient and don’t get cross – they’re not doing it to annoy you. Work with your child and keep them involved in the process. Remember the regular fluids and encourage regular visits to the toilet, and don’t forget to praise them.