Bowel and Bladder Training Recommendations
The goal is for children to void every 2 hours during the daytime. Your child can do this by following normal transition times in their daily routine. For example, they could void upon awakening, mid-morning, at lunch time, mid-afternoon (after school), at dinner time, and before bed.
A timed voiding routine can also be accomplished by scheduling a trip to the bathroom between class periods or between other breaks at school. We can provide a note for your child’s school teachers to allow your child to have bathroom privileges.
Some children like to use a “potty watch.” Any watch that has a timer or alarm can be set to remind your child to use the bathroom at the appropriate time. A “potty watch” should either ring or vibrate to remind your child to void.
A bladder chart can also be useful to keep track of trips to the bathroom. Your child can place a check mark on the chart (or a sticker) once they have voided at the specified time.
When using a double-voiding approach, please have your child take their time and void normally. Once your child feels that they have finished, have them count to 10, then try to void again.
This approach can help children who have trouble emptying their bladder completely and may decrease bladder infections and wet accidents.
Wide-Legged Voiding/Reverse Toilet Voiding
Vaginal voiding occurs when urine from the bladder collects in the vagina during urination. Girls with this problem will often complain that they continuously leak urine, or that they have leakage a short time after going to the bathroom to urinate. They often have irritation in the genital area, and have persistently damp panties.
We treat this problem by adjusting your child’s position on the toilet during voiding. Girls can urinate using either of these positions:
- Sit on the toilet with legs spread far apart and lean forward during voiding, OR
- Turn around and sit backwards on the toilet seat. This ensures that the legs are spread widely and that the child is leaning forward during voiding. With this approach, it is sometimes helpful to clean off the tank of the toilet and place a towel or other padding for your child to rest their arms on while voiding. This allows the direction of the urine to go forward instead of backward when voiding.
With either position, we will sometimes ask you to have your child double void, as well (see description above). It may take a few days to see improvement.
Constipation Management and Treatment
Constipation plays a big role in bowel control problems, bladder control problems, and urinary tract infections. It can contribute to bowel accidents, wetting accidents, frequency of urination, urgency of urination, and urinary tract infections. For a child with any of these problems, constipation treatment is very important. The typical approach to treating constipation has three basic parts:
Adequate water intake is important for both bowel and bladder health. Water should be consumed throughout the day.
Get Plenty of Fiber
Your child should have adequate fiber content in their diet. A simple rule of thumb to calculate the minimum daily amount of fiber, in grams, is to take your child’s age and then add five. There are several ways to meet your child’s daily fiber goal. Dietary sources of fiber include fruits, vegetables, nuts, and grains. Dietary sources of fiber are preferable because they also contain other healthy nutrients.
If your child is unable to meet the daily fiber target with dietary sources, there are several ways to supplement dietary fiber. Fiber gummy bears, Metamucil, Benefiber, and Fiber-One bars are just a few of the several choices available.
If hydration and dietary fiber are not sufficient to control constipation, we will often use medications that make the poop soft and watery. We commonly use MiraLAX, which can be given daily. It comes as a powder that can be dissolved in water or juice, and it can be purchased over the counter. We may suggest other approaches such as enemas or suppositories, or an at-home bowel cleanout, as needed. Occasionally, we will refer you to a constipation specialist (gastroenterologist).