Bladder Control Problems Wet No More

Wet No More

In midafternoon comes the call from your daughter's school: She says she doesn't feel well and you must come get her. Worried, you rush to the school. Only when you get your ashen-faced daughter in the car does she admit that she's not ill at all--she just wet her pants.

It's a humiliating experience for a child who's past the toilet-training years. But accidents do happen. Sometimes a child will wet her pants during a fit of shrieking laughter; sometimes she's so engrossed in an activity that she puts off going to the bathroom until it's too late. Even constipation can lead to daytime wetting accidents.

It may not happen again, if your child and you can work out ways to prevent it. But before you attempt a home remedy, see your pediatrician or family physician to rule out physical causes or health problems, such as urinary tract infections and bladder abnormalities. Then try these approaches.

Treat constipation. Constipation can indirectly cause daytime wetting, says Joseph Hagan, M.D., clinical assistant professor of pediatrics at the University of Vermont College of Medicine in Burlington and a pediatrician in South Burlington.

A constipated child who has had a painful bowel movement wants to avoid the pain she associates with going to the bathroom, says Dr. Hagan, so she tries to ''hold it in.'' This is where the problem starts. ''Some kids who are plugged up with stool develop sphincter confusion. They think they're holding onto stool, but they're also holding onto urine,'' explains Dr. Hagan. When the child just can't hold the urine any longer, accidents occur.

If your child is constipated, encourage her to drink plenty of fluids and serve her fruits, vegetables and whole grains. If the problem persists, ask your pediatrician for advice.

Turn off the tube. Kids can get so engrossed in a television show or video game that they don't take a break to go to the bathroom. '' When they wet during an activity, that activity should halt immediately and not be turned back on for half an hour,'' says Barton D. Schmitt, M.D., professor of pediatrics at the University of Colorado School of Medicine, director of consultative services at the Ambulatory Care Center at Children's Hospital of Denver and author of Your Child's Health. Explain to your child that if he can't remember to stop to relieve himself, you'll have to limit video or T V time.

Put your child in charge. It should be your child's responsibility to remember to go to the bathroom, says Dr. Schmitt. Reminding the child only makes the problem worse: If you take charge, then your child doesn't have to. ''It's also very intrusive to tell a child to go to the bathroom when he doesn't need to go or when his bladder's only half full,'' points out Dr. Schmitt. ''The only one who knows when the bladder is full is the child.''

Reward dry days. Be sure to compliment your child when she doesn't wet, says Patrick Holden, M.D., associate professor of psychiatry at the University of Texas Health Science Center at San Antonio--and avoid punishment when she does. Encouragement can come in the form of hugs or positive statements, says Dr. Holden. It helps to put a calendar in the child's room and mark it with stars or stickers for dry days.

Have short-range goals. If you're going to reward your child for staying dry, make sure it's a goal the child can attain in the near future, says Dr. Schmitt. Don't make the mistake that one mother did, who promised her son a treat if he could stay dry five days in a row. ''The child had rarely been dry one day,'' says Dr. Schmitt. ''There's no value in setting a five-day goal that he can never achieve.''

Empty the bladder. Parties or sleepovers are high-risk activities for kids prone to lose bladder control when they're laughing hysterically. Remind them to empty their bladders immediately before the event, says Dr. Schmitt.

Cut back on excess fluids. Never restrict what your child drinks to quench his thirst, says Dr. Holden. The drinks to watch out for aren't really thirst-quenchers--they're just sweet and tasty. ''It can help to restrict access to sodas and soft drinks,'' he says. '' Your child might drink them not because he's thirsty, but because they taste good,'' he says. You can make a simple rule that the child may drink only a certain amount of juice or soda daily, although he can drink as much water as he wants.

Help your child practice control. Deliberately stopping and starting while urinating helps improve bladder control, says Dr. Schmitt. Explain to your child how to do this, and ask him to practice every time he urinates.

Change her stance. When a girl is in a hurry to go to the bathroom, she may not take the time to pull her pants all the way down. If she ends up urinating with her knees together, this can push urine up into the vagina, explains Thomas Bartholomew, M.D., a pediatric urologist and assistant professor of surgery and urology at the University of Texas Health Science Center. And when she stands up, the pooled urine runs out, leaving an embarrassed child with wet underwear.

Remind your daughter to urinate with her knees apart. If she can't remember, ask her to sit on the toilet backward, says Dr. Bartholomew. That position makes sure that her knees remain apart while she's urinating.

Beware of tights. In girls, tight-fitting clothing can cause inflammation that leads to wetting problems, says Dr. Hagan. Warm winter tights can cause perspiration, then vaginal irritation and painful urination. If your daughter begins to have problems, ditch the tights and have her wear loose, long pants instead.

Avoid bubble baths. These can cause an inflammation of the genitals in girls, which can in turn cause incontinence, says Dr. Schmitt.