Why Is My Child Having Accidents After Being Toilet-Trained?

If your school-age child begins having wetting accidents after being toilet-trained for at least six months, you may be concerned — and rightfully so. The good news is that most bladder control problems in children are not serious and can be treated with behavior modification. Catching these issues early makes it easier to break the dysfunctional habits.

What Are Bladder Control Problems?

Most bladder control problems in children are the result of pelvic floor dysfunction that develops over time.

Healthy infants are born with a reflex that causes their bladders to empty when full. As they grow, children learn to wait to urinate until they reach a toilet because they can control the sphincter valve and pelvic floor muscles. Plus, their bladders are larger and can hold more urine.

When children repeatedly ignore the signals that they need to empty their bladders, they become desensitized to the normal sensations and bladder control problems can take root.

Types of Bladder Control Problems

Bladder control problems in children can come in many forms, including:

• Daytime wetting: the loss of bladder control in children who have been toilet trained during awake hours
• Frequency: when your child has to urinate more than eight times during awake hours
• Hesitancy: trouble starting or taking a long time to start passing urine
• Holding maneuvers: your child does things to avoid going to the bathroom, such as squatting, leg crossing or holding the genital area
• Infrequency: when your child doesn't urinate enough during awake hours (fewer than three times)
• Intermittent urine stream: the flow of urine occurs in bursts rather than a normal continuous stream
• Post-void dribbling: leaks of urine that occur immediately from sitting position soon after going to the bathroom
• Straining: trouble getting urine out
• Urgency: a sudden, unexpected need to urinate
• Weak urine stream: the flow of urine is weak or slow

How Constipation Is Related

As many as 80 percent of children who have bladder control problems also suffer from constipation. This is known as bladder and bowel dysfunction (BBD).

When your child cannot poop regularly, it backs up in the rectum and colon. Because the rectum is behind the bladder, it can push on the bladder when it is full of poop. The bladder also can't hold as much urine when this occurs. This pressure can cause urinary frequency.

Constipation also affects bladder issues because the pelvic floor muscles control both the bladder sphincter and anal sphincter. Children who feel pain from constipation when they poop tend to hold in their stool. This causes them also to tighten the bladder sphincter, which holds in urine and can lead to urinary infrequency.

Treating Bladder Control Problems

Wetting accidents in school-aged children can cause stress for kids and parents alike. Fortunately, most bladder control problems in children are from bad habits that easily can be changed with patience and care. It’s rare for there to be any long-term effects. Treatments include:

• Avoiding and treating constipation. You can make sure your child gets enough fiber in their diet, drinks enough water and takes a stool softener or laxative if recommended by your child’s pediatrician.
• Behavioral training for wetting. Your child’s pediatrician may recommend that your child sit on the toilet at regular intervals and just relax, not try to go, to help them learn to stop withholding.
• Pelvic floor therapy. Exercises to work on abnormal pelvic floor muscle contractions can help with voiding dysfunction. Some types of pelvic floor physical therapy use biofeedback in the form of video games, teaching your child when it is the right time to relax or contract their pelvic muscles.