If your child can’t stay dry at night after 5, or can’t make it to the potty on time, there are a number of things that could be going wrong. I won’t list them all, but your pediatrician may send you to a pediatric urologist to evaluate whether there are any functional (kidney issues, thyroid issues, adrenal issues etc.) or structural issues ( nerve, tissue malformations). If testing results are negative, some parents actually feel worse rather than better.
Why? Because they may be facing a situation that is harder to evaluate and treat: low tone reducing sensory awareness and pelvic floor control.
Yes, the same problem that causes a child to fall off their chair without notice can give them potty problems. When their bladder ( which is another muscle, after all) isn’t well toned, it isn’t sending sensory information back to the brain. The sensors that respond to stretch aren’t firing and thus do not give a child accurate and timely feedback. It may not let them know it is stretched until it is ready to overflow. If the pelvic floor muscles are also lax, similar problems. Older women who have been pregnant know all about what happens when you have a weak pelvic floor. They feel like they have to “go” but can’t hold it long enough to get to the bathroom! Your mom and your daughter could be having the same problems!!
What can you do to help your child? Some people simply have their kids pee every few hours, and this could work with some kids in some situations. Not every kid is willing to wear a potty watch (they do make them) and the younger ones may not even be willing to go. The older ones may be so self-conscious that they restrict fluids all day, but that is not a great idea. Dehydration can create medical issues that they can’t fathom. Things like fainting and kidney stones.
Believe it or not, many pediatric urologists don’t want kids to empty their bladder before bedtime. They want kids to gradually expand the bladder’s ability to hold urine for a full 8-10 hours. I think this is easier to do during the day, with a fully awake kid and a potty close at hand. Too many accidents make children and adults discouraged. Feeling like a failure isn’t good for anyone, and children with low tone already have had frustrating and embarrassing experiences. They don’t need more of them.
There are a few ideas that can work, but they do take effort and skill on the part of parents:
First, practice letting that bladder fill up just enough for some awareness to arise. You need to know how much a child is drinking to figure out what the right amount is, and your child has to be able to communicate what they feel. This is going to be more successful with children with at least a 5-6 year-old cognitive/speech level. Once they notice what they are feeling down there right before they pee, you impress on them that when they feel this way that they can avoid an accident by voiding as soon as they can. Try to get them to create their own words to describe the sensation they are noticing. That fullness/pressure/distention may feel ticklish, it may be felt more in their belly than lower down; all that matters is that you have helped your child identify it and name it.
You have to start with an empty bladder, and measure out what they are drinking so you know approximately how much fluid it takes them to perceive some bladder stretching. It helps if you can measure it in a way that has meaning for them. For me, it would be how many mugs of coffee. For a child it might be how many mini water bottles or small sport bottles until they feel the need to “go”. You also need to know how long it takes their kidneys to produce that amount of urine. A potty watch that is set to go off before they feel any sensation isn’t teaching them anything.
The second strategy I like involves building the pelvic floor with Kegels and other moves. Yup, the same moves that you do to recover after you deliver a baby. The pelvic floor muscles are mostly the muscles that you contract to stop your urine stream. Some kids aren’t mentally ready to concentrate on a stop/start exercise, and some are so shy that they can’t do it with you watching. But it is the easiest way to build that pelvic floor. There are other core muscle exercises that can help, like transverse abdominal exercises and pelvic tilt exercises. Boring for us, and more boring for kids. But they really do work to build lower abdominal strength. If you have to create a reward system for them to practice, do it. If you have to exercise with them, all the better. A strong core and a strong pelvic floor is good for all of us!
Tell your child to stand up and check again to see if he “has to go”. Why? Because the extra force of gravity on that full bladder will add sensory information. Many children with low muscle tone sit or lie down while playing. The force of a full bladder isn’t felt as intensely, and young children aren’t always able to parse the small cues. Stand up, and there should be more force on the internal sphincter and more of a sense that it’s time to use the toilet.
Finally, don’t forget that the same things that make adult bladders edgy will affect kids. Caffeine in sodas, for example. Spicy foods. Some medications for other issues irritate bladders or increase urine production. Don’t forget constipation. A full colon can press on a full bladder and create accidents.
Interested in learning more about toilet training? My e-book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone is available on my website, tranquil babies. Just click ‘e-book” on the ribbon at the top of the home page, and learn about my readiness checklists, and how to deal with everything from pre-training all the way up to using the potty in public!
