4 Year Old small bladder capacity, how to help him, always urgently needing to go.

[Onestressedmama]

Not sure where to start. I just sit here crying because I feel it will never get better. Firstly, I appreciate he is only 4 and a lot of children still struggle, I've been a preschool teacher for 10 years so I've really seen it all, but my own child has left me stumped.

Aged 22 months, his friend began toilet training and my son "want to us potty like Charlie" so we went with it! Dry in a week, asking to go to the toilet, dry when we went on days out. Perfect. 25 months, 10 accidents a day. Not big full wet accidents (he's actually only ever had 1 full wee to the floor accident in 2 years). But he is still....2 long years on, wetting through his trousers up to 10 times per day. Around 50p size to maybe an inch or 2.

He constantly needs a wee, probably goes 15+ times a day. Doctor gave us a drink and wee schedule but he gets so upset during the hour he was to wait and then needs to go so urgently he wets. We've never got passed the 30 mins stage.

Referred to paediatrition who said he's constipated, I'm not convinced as he goes for a poo happily and comfortably once or twice a day, however we have started Movicol now anyway.

But now we face the battle of wills too, because he just cannot be bothered to go the loo that many times (and who can blame him). And he just wets and says "I don't care, I don't want to go".

He starts school soon and I am worried about potential bullying. I think there's something more than potential constipation, I don't think his muscles are working efficiently. But why were they working when he was 2 and now they're not? I'm so stressed and he's so stressed and I just do not know where to go. Paediatric follow up is in 14weeks (6 months after 1st appt) but then we are emigrating so it seems pointless.

Have tried:

Drink and wee schedule, potty in living room, no squash only water to drink, positive reinforcement (medals, sweets, sticker charts, special game time with mummy and daddy, Peppa Pig world..), new pants, new clothes, allowed the iPad on the toilet to relax and let all the wee out....

Why am I failing so much here

[Alicass]

I'd get him checked again for constipation just in case. Ask for a bladder scan. They measure how much urine the bladder holds when needing to go to the toilet and what's left after they've been to the toilet. My son had one month's ago. He was desperate for the toilet but only had 49ml of urine in his bladder and he was desparate to go. He has suffered from chronic constipation which is a lot better now we're on Movicol and have disimpacted 5 times in the last 14 months. They've said he could be left with an overactive bladder but we need to wait until he's fully recovered from the symptoms of constipation. Keep fighting as incontinence isn't supported a lot in the NHS. It's a very stressful and emotional issue to deal with. We've found it really hard but there's light at the end of the tunnel now. Good luck. Xx

[Onestressedmama in reply to Alicass]

Thank you very much, I think my son is the same, he's desperate but doesn't wee much at all and it's always so clear. It's exhausting for us all. He's started Movicol now so I will keep up with it. My worry is we move to Australia in a few months, and I just don't want to start the process all over again. I'm so angry at myself for not pushing this further but everyone says it's his age, should have listened to myself though as I know there's more to it. X

[Alicass in reply to Onestressedmama]

Get him checked out as soon as so at least you have an idea of what your dealing with.

[Onestressedmama in reply to Alicass]

Thank you so much for your advice, it really is appreciated x

[Helen36]

You are not failing!!! There are hundreds of us on here that could have written this exact same thing. And this is where I first started with my little girl xxx

Bizarre as it sounds, it is likely that poo is the culprit here. Not necessarily constipation as we think of it, but a build up of poo in his tummy which is pressing on his bladder. This can be the case even if poos seem normal. Sometimes this constant pressing on the bladder can make the bladder leak, and over time it can make the bladder irritated so it twitches constantly (‘an overactive bladder’). The valve at the top of the urethra thickens to try and deal with the downward pressure of the twitching muscle and ironically - leaks more!

The accidents up to every 30 minutes sound like this might be where you have got to (but I am not a doctor).The first step is to start with the poo (and this is why the clinical pathway for wetting is to treat for constipation). You might want to talk about a disimpaction (to clear the bowel) with the paediatrician or just try upping the movicol which may give you a small improvement on the wetting front. I also really recommend asking him to sit on the loo and try for a poo after every meal - as this is when he is most likely to feel the urge and get any poo in there out.

For the bladder, a drinks schedule to help the bladder learn the sensation of emptying and refilling is good to do - and definitely avoid bladder irritants like squash - but this isn’t going to help solve it for you anytime soon. There are medications that can treat an overactive bladder and once you have a good poo routine going and the movicol side of things is established, you’ll probably need to discuss that with a doc. But you need that bowel away from pressing on the bladder first.

For sanity - tell yourself and your son it is a naughty bladder: it is not him having an accident, it is the naughty bladder. It is not him that makes you cross, it is the bladder. And it is ok to be cross about it! Reward him for changing himself and set up a station of pants and trousers in the loo for him to be as independent as possible. The dry like me pads you can buy were a total life saver for us when things were bad and made places like soft play and parties possible.

On school, I know the thought of it is so stressful, but he will be fine. This is SO common and our reception teacher reassured me that every single child in the class had had an accident in the first term so he won’t stand out. Talk to school before he starts about how to help him manage it, and if they aren’t helpful - talk to the senco officer. This forum can always help with rights and school responsibilities. (And find a source of second hand school uniform for all those spares...)

In terms of bullying, children do not bat an eyelid at a bit of wee or poo and I have found them all remarkably kind about it. My daughter is now year two and she is one of three in her class with ongoing bladder and bowel conditions that mean soiling and wetting.

But.. she is much better now. It has been one hell of a journey and I remain constantly obsessed with her bowel movements because as soon as she backs up, she can start wetting again. But not back to the days of the over active bladder like you describe and we had when she was 4.

The good news is you have realised already that something is not right (proving that you are 100% not failing but actually succeeding!!), got some medical support - and found this forum. Hard as it is to come to terms with, there are no quick fixes, but have faith he will get there. Xxxx

[Onestressedmama in reply to Helen36]

Thanks so much for your kind and lengthy reply. It genuninely made me cry.

All of my family and friends just don't get where I'm coming from, they insist he is just being stubborn, doesn't care, won't care. If another of my friends tells me how they toilet trained their 2yo I don't think I could listen. I know how to toilet train a child, I've trained 100s in my time as a Pre-School teacher. I know this is different.

I will definitely speak to the GP again, our paediatrician is under funded so unless it's a scheduled follow up he won't see you, which is annoying as he is amazing. But what can you do.

I can't tell you how reassuring it is to know I'm not alone. Can I ask, when your daughter's bowels are controlled, is she usually dry now or still some problems?

His bowels are seemingly good, although I of course recognise that there could be some back up blockages, but he hasn't ever had a poo accident and I don't want to risk adding that to the problem and giving him extra anxiety.

Thanks for the advice about the Naughty Bladder, I wish I had thought of that before this morning before I absolutely LOST it with him, screaming match on the Naughty step. Argh. So beyond mad at myself. But he wet 3 times whilst trying to leave for Pre-School and with my 9 month old screaming every time I put her down I just let the frustration get to me. Feel so annoyed at myself. 2 years we've been in pants I'm just so fed up! And now I'm crying again haha x

[Helen36 in reply to Onestressedmama]

Oh poor you!!! Sending you a big virtual hug. A 9 month old as well is tough and I am sure the move is a big stress as well. My younger one was also a baby as this all kicked off for us and the exhaustion of it all is so hard. My absolute low point was screaming ‘what is wrong with you??!!’ at my then three year old as she wet herself leaving the bathroom after a wee. It still makes me feel sick to think about it. I think it helps to think of you and him as a little team working against this. He genuinely won’t be able to feel it or stop it coming so let him know you understand this and that you are learning too. I think we sometimes have to hit these lows to move forward!

Unfortunately it often looks like they don’t care or are being stubborn - and of course they don’t want to go to the loo all the time - it is boring!!! Family will get it, in time. It’s a miracle I am not doing time for murder after one helpful relative offered to take my daughter for a morning to teach her ... I have to laugh now I have the hindsight of it!!

So we do have good periods now of total dryness (even at night) and no soiling. Our best run was about 4 months of total normality last year. She remains on quite a high dose of movicol and something else that’s a laxative but every now and then, things start to go down hill (usually night first), then wetting and / or soiling. Curiously when this all first started we had a long time with no soiling but it is part of our picture now when things go down hill. I can usually get it back on track pretty swiftly now.

Have a really good read of all the information on the ERIC website and learn as much as you can about it. There’s a lot of information on disimpactions on there and definitely worth talking through with your GP. Your area might have a children’s continence nursing team. You’re unlikely to get through a referral before you move but you could ask your GP to see if s/he can speak to someone for you to get some advice. There is an ERIC helpful which is amazing but unfortunately can be hard to get through to.

Xxx

[Onestressedmama in reply to Helen36]

So after your lovely message I got a call from nursery to say he literally can't stop weeing, it's like a tap that can't be turned off, he's getting of the toilet and still weeing. I just broke down again felt so helpless. Managed to get him a Dr appt though, they are treating him for a urine infection although they've sent it off for testing so won't hear until Monday, but the doctor said he had never ever seen wee so clear in a child, literally like water!! I also went armed with the ERIC chart for disimpaction and the Dr agreed there was no real harm in giving it a go, so he gave us more Movicol and said to follow the advice on here and call back if any problems. He also said to call the Paeds for an urgent follow up since we are moving soon and if they say no then he will call them. It's just important we have all medical records up to date before we go really. Thank you for being the listening ear I needed earlier. Still emotional and upset, but we had a long talk about naughty bladders (which he found hilarious) and hopefully it takes both of our anxieties away xx

[Child_2012]

This is literally what my son was like - we faced criticism that we had failed potty training, constant arguments over it, upset child, washing piles .......

After constant pushing to see paediatric urologist and investigation turns out he has an overactive bladder that is controlled now with medication.

Keep pushing to see a paediatric urologist and get the scans/answers

[Mama-Llama]

Hi there

Sounds very similar to my 5.5 your old boy. We struggled for 18 months then he was diagnosed with over active bladder by dr Wright at the Evelina children’s hospital (we self referred for an appt as no one we had seen locally either understood or took it seriously). My son is now on oxybutynin and it has changed everything - he also has 1 movicol a day as there were also a few poo issues. He has also learned to drink about 1.5 litres of water a day which is a big help. Fingers crossed he is completely dry in the day now and poos regularly.

Good luck and don’t give up 😘

[Onestressedmama in reply to Mama-Llama]

Just had a look at self referring but couldn't see this as an option? Would be fab if we could. Your reply did lead me to googling local paediatric urologists and there's one very local to us who is private (£215 per appt, ouch) but we would get seen within a week!! So that's definitely something to explore since we don't have long before we move. So thank you for your comments because I never would have thought about a self referral cx

[Lebowskithecat]

Hi, my daughter is nearly 4 and your post describes her down to a tee. Showed interest in potty training early and succeeded for a short while. Now almost a year and a half later and can have lots of accidents a day. Knickers are constantly soggy and most of the time doesn’t even seem to notice. We’ve just gone back to preschool after the half term and she’s gone back to full blown accidents there. Nurse said there’s no UTI and felt her tummy and couldn’t feel any large mass/constipation. Like your son she poos easily once or twice a day- never had any poo accidents. We’re now on a waiting list to see a paediatrician. It’s very lonely and frustrating, I also have many friends that have managed to train their two year olds and it’s horrible having no one to talk to about it. It’s nice to come on here and see some success stories. I know in my gut that something just isn’t right. Really hope there’s some progress for you soon! It’s stressful knowing they start school in September. Have you tried the dry like me pads? They give us a little bit of reassurance when we’re out and about.

[Onestressedmama in reply to Lebowskithecat]

Just breathed a sigh of relief reading your comment. Although I feel sad for both you and your daughter, as you say, it's comforting to know we aren't alone.

The referral process takes so long and even though we have been seen before, getting a follow up Paeds appt is taking forever too.

As mentioned above, we move to Australia in 13 weeks and I don't really have time to wait now, so may actually pay for a private referral. Although nobody seems to really want to help until they are 5 as it's developmental....but as you say, you KNOW it's something more.

Yes I actually just brought the pads this week, only used them once and he weed through it, I think he felt like he could. A friend did say about wearing 2 pairs of pants, one under the pad as he can then still feel when he's wet so I may try it.

It's such a worrying time isn't it, so fingers crossed they both get the help they need soon. Xxx

[Lebowskithecat in reply to Onestressedmama]

I feel you! So frustrating and lonely! Although my family and friends are all very supportive and it seems the preschool have dealt with it all before. Doesn’t make it any easier. Moving to Australia will come with its difficulties I’m sure but hopefully you can get some follow on support over there. Our paed appointment is in May but I really have no idea what to expect. I know it’s not going to be a miracle but it’s a starting point. I would defiantly pay for private if we weren’t getting anywhere with our docs. Yeah the pads are ok for small dribbles- I take it your little one is still in night time nappies? Ours is super full in the morning! I’m guessing that’s another battle for another day! Wishing you all the luck, keep us posted with what you decide to do before the move!

[Onestressedmama in reply to Lebowskithecat]

Oh yes very very very much soaked nappies at night. He only learnt to sleep through the night a few months ago so I'm going to enjoy that before I unsettle him to start (and probably fail) night time training!

Yep, I'm sure Aus will bring a whole heap of challenges, I had hoped this wouldn't be one of them, but it's looking likely that it will. We shall see.

Thank you again for reaching out, best of luck for you too ♥️

[Lebowskithecat in reply to Onestressedmama]

I forgot to mention that we also have a 14 month old sibling in the mix who insists on coming into the toilet with us every visit! Toilet trips are very manic and usually end up with a change of knickers. The best way I have learnt to deal with things is that I just keep saying to myself “it’s only wee”. Just have to be thankful that our children aren’t unwell in any other way! Although I do pray with my second child that things will go a lot more smoothly and we don’t encounter the same problems. That would just be very unlucky! I wouldn’t worry about the nighttime training just yet, I have read on here kids being in pull ups at all ages. Best of luck with your move, happy to keep in contact on here with our progression if it’s helpful.

[Blackpanda]

You can buy dry like me pads from Asda & Morrisons which will help when he starts school. You can’t tell they are in the pants & will help with little leaks. My son has always needed the toilet often but once he started juniors is wet everyday during the winter months. The cold makes him need a wee desperately. The doctors say they are not allowed to give him oxybutin for an over active bladder although I’ve seem on here plenty of children have it. He starts secondary school soon and we are no closer to solving the problem.