At what age should a child have bladder control

Once your child has been successfully potty-trained – ‘taking care of business’ should get easier – but what if the accidents keep happening?

When a child over the age of four has frequent daytime urinary accidents, and there doesn’t appear to be an underlying medical cause, he/she may be diagnosed with voiding dysfunction. Voiding dysfunction is very common, and can be used to describe problems with either holding urine in, difficulty emptying the bladder or urinary incontinence.

No one knows what causes voiding dysfunction, but the condition can impact children physically, socially and psychologically. Left untreated, some types of voiding dysfunction can cause permanent kidney damage over the long run. Luckily, there are several types of treatments that can help children successfully regain control of their bladder.  Here are a few signs that your child may have voiding dysfunction:

Feels an urgent need to go without a full bladder.  Children with overactive bladder (OAB) may sense the urge to use the bathroom every hour or more. Most children with OAB will have urinary incontinence and some may develop urinary tract infections (UTIs); sometimes these OAB symptoms will continue even in the absence of urinary infection. Some children may (unsuccessfully) try to “hold it” by crossing their legs or using other physical maneuvers. OAB is treated with behavioral therapy to retrain the bladder through scheduled potty times but sometimes also requires medications that reduce the urge to urinate.

Feels like the bladder is still full, even after going to the bathroom.  In children with dysfunctional voiding, the muscles that control the flow of urine out of the body don’t relax completely, and the bladder never fully empties. This causes a range of symptoms such wetting during the day and night, a feeling that the bladder is always full, urgency, and straining to urinate. Children with this condition are at a higher risk for getting kidney infections. Dysfunctional voiding is treated with medicine to relax the bladder and behavioral therapy to retrain the brain and bladder to work together.

Urinates less than 3 times a day. Children with an underactive bladder are able to go for more than 6-8 hours without urinating. These children sometimes have to strain to urinate because the bladder muscle itself can become “weak” from being overstretched and may not respond to the brain’s signal that it is time to go. Accidental wetting with underactive bladder is caused by when the bladder becomes too full and overflows. These children are started on a timed voiding schedule such they try to go to use the restroom every few hours regardless of their perceived urge to urinate. This more frequent voiding schedule can help the bladder from becoming overstretched and restore the muscle tone.

Frequent constipation with daytime urinary incontinence. Studies indicate that almost ALL children with voiding dysfunction also have some element of constipation/fecal retention or bowel dysfunction. A major element of treating voiding dysfunction is aggressive therapy for relieving fecal retention. In many cases when the constipation is treated appropriately, the children’s bladder symptoms will improve or go away.

Bedwetting at night and having other bowel accidents. Bedwetting at night is very common in children even after successful toilet-training during the day. Most children who only wet the bed but have no daytime issues will not have abnormal urinary tract anatomy. However, children who wet the bed and also have bowel accidents (also known as encopresis) may have functional issues with the nerve signals to their bladder and/or bowels. When the signals to the bladder are disrupted, the same nerves that control bowel continence may also be affected and children may have difficulty controlling their bowel movements.

Over the age of 4 and successfully potty-trained, but still having daytime accidents. Voiding dysfunction is not typically diagnosed until a child is older than 4 and continues to experience daytime accidents for at least 6 months after toilet training ends.  As a first step, a urologist will exam your child to see if there are any medical or anatomic reasons that could be causing daytime wetting. If the examination doesn’t reveal any issues, the physician may order additional testing that look at how the bladder is functioning and evaluate for evidence of bowel dysfunction.

If you think your child has any of these bladder issues or symptoms, call the Nationwide Children’s Hospital Urology Clinic (614) 722-6630 for an appointment to arrange for further evaluation and treatment.

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Healthy Children > Ages & Stages > Toddler > Potty Training > The Right Age to Potty Train

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The Right Age to Potty Train

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One skill children need to learn is when and how to use the toilet. Here are general potty training tips that can help you begin the process. If your children have special health care needs, some tips may need to be modified. Talk with your child's doctor if you need specific guidance.

Learning to use the toilet

Potty training is a process that involves the body and the mind.

• First, children need to be aware of their own bladder and bowel signals. They need to learn when their bodies are signaling them that it's time to urinate or have a movement. In general, children show signs of bladder and bowel control between 18 and 24 months of age.

• Second, children need to learn how to use the toilet. Children must be able to understand instructions and follow them. For instance, they have to be able to sit or stand comfortably. They have to be able to pull down their pants and underpants, as well as pull them back up.

• Third, once children have bladder and bowel control and they know how to use the toilet, they need to be willing to use it. Toilet training struggles happen when children choose not to use the toilet. It's important to remember that children can succeed at using the toilet but in their own time.

When to start potty training

Toilet training may come up during children's 18-month, 2-year, 2½-year, and 3-year well-child visits. The average age toilet training begins in the United States is between 2 and 3 years of age. Most children in the United States are bowel and bladder trained by 4 years of age. However, toilet training can begin as soon as parents and children want to start.

In general, here are signs a child may be developmentally ready to begin the toilet training process. If you have any questions or concerns, talk with your child's doctor.

• Is dry at least 2 hours at a time during the day or is dry after naps

• Shows signs they are about to pee or poop, like grunting, freezing, or squatting

• Can follow simple instructions

• Can walk to and from the bathroom and help undress themselves

• Does not like to be in wet diapers and wants to be changed

• Asks to use the toilet or potty-chair

• Asks to wear "big-kid" underwear

Potty training tips

Here are toilet training tips to help start the process. Parents can help empower their children to be in control of their own toilet training.

1. Keep the process positive. Choose the words your family will use to describe body parts, urine, and bowel movements. Avoid words that are negative, like dirty, naughty, or stinky.

2. Pick a potty-chair. A potty-chair is a child-sized seat with an opening in the seat and a removable container underneath to collect pee and poop. Children's feet should be able to reach the floor. Books or toys for "potty time" may help make this time more fun.

3. Be a role model. Let your children see you use the toilet and wash your hands afterward.

4. Know the signs. When your children feel the urge to poop, you might notice grunting, squatting, or freezing. Children's faces may turn red while pooping. Explain briefly to your children that these signs mean a poop is about to come. If your children tell you about a wet diaper, praise them for "using their words." It may take longer for children to notice the need to pee than the need to poop.

5. Think of toilet training as toilet mastery. Invite your child to take over their toileting. Talk with them about how they will now be in charge of their pee and poop. Read children's books about using the toilet to help the process make sense and seem inviting and exciting. When you start the process, try to turn as much of the care of toileting as possible over to your child. Remember, if parents are in charge, there is less room for children to step in and take charge.

6. Make trips to the potty-chair a routine. Routines are important, and practicing the steps is helpful. Make a habit of seating your children onto the potty-chair first thing in the morning. Boys can urinate by sitting down first and can stand up to urinate when better at it.

7. Expect hesitancy. Taking over toileting is a big step. Many children want their parents to take care of their pee and poop and may seek ways to keep parents involved, such as peeing and pooping into their pants. Gently help them overcome their hesitation. Then help them stay in charge by having them be in charge of the cleanup.

8. When toilet training starts, switch to big-kid underwear. Talk with your children about taking control and toileting into the toilet and not their underwear. Some parents may use cloth training pants, which are a little thicker, to protect children's clothing. (Diapers and disposable training pants send a message to children that they are not taking over and do not need to learn to use the toilet.)

9. Teach your children proper hygiene habits. Show your children how to wipe carefully. Girls should spread their legs apart when wiping. They should wipe thoroughly from front to back to prevent bringing germs from their rectum to their vagina or bladder. Make sure both boys and girls learn to wash their hands well after using the toilet.

10. A word on praise. Taking over toileting is something all healthy children do. Achieving mastery is the best reward for toilet training success. Avoid treats and punishments. Because this is an adventure for your children—a reach for new responsibility— treats and punishments distract rather than encourage. When your children succeed, be specific about why you are proud—"I am so proud you are able to use the toilet so well," for example.

11. Avoid a power struggle. Children at toilet training ages are becoming aware of their individuality. They look for ways to test their limits. Some children may do so by holding back bowel movements. Try to stay calm about toilet training. Remember that children control when and where they pee and poop. So power struggles, begging, pleading, rewarding, and punishing keep children from managing their own toileting.

12. Understand their fear. Some children believe that their pee and poop are part of their bodies. They may be scared the toilet will flush parts of them away. Some may also fear they will be sucked into the toilet if it is flushed while they are sitting on it. To give your children a feeling of control, let them flush the toilet.

13. Watch for a desire to move up. Most of the time, your children will let you know when they are ready to move from the potty-chair to the "big toilet." Provide a stool to brace their feet.

When potty training should be put on hold

Major changes in the home may make toilet training more difficult. Sometimes it is a good idea to delay toilet training if

• Your family has just moved or will move in the near future.

• You are expecting a baby or have recently had a baby.

• There is a major illness, a recent death, or some other family crisis.

Remember

If any concern comes up before, during, or after toilet training, talk with your child's doctor. Often, the problem is minor and can be resolved quickly. Sometimes, physical or emotional causes will require treatment. Getting professional help can make the process easier. If your child needs additional care, your child's doctor may suggest another pediatric health care specialist who can address the specific pediatric needs of your child.

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The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

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