Overactive bladder / impaction / something else?

[AtoZtoA]

My 3.5yr old (daytime toilet trained for over a year, uses nappy at night which are always wet) is having loads of daytime wetting accidents with small wet patches often appearing on her pants just 30mins or less after she's had a wee (which grow if we don't get her to the toilet fast). The more she drinks, the less able she is to stay dry - it's like she has a tiny bladder so if she drinks a 150ml cup of water it triggers multiple wees in quick succession. She gets fed-up of having to go to the toilet so much, hence accidents, but also there's often only a minute or so between her starting to feel the need and being absolutely unable to stop the wee coming so there's an urgency issue as well as frequency. We've had a urine test done which has ruled out a UTI. We have tried a bladder diary and it seemed leaks started after about 60ml in the bladder. Largest wee we got was c.90ml, and she'd been slowly leaking for a while that time before she went. Quite a few wees were only 20ml or 30ml, despite her being desperate. We're going through a particularly bad patch on this just now, but it's probably been going on for best part of a year, sometimes better, sometimes worse.

Constipation seems to be the 'standard' answer but I can't quite work out if it fits. She does a good 'smooth sausage' type poo every morning, but does often also do a number of 'partial' poos later in the day (not hard, or mushy, just smaller bits of smoothish poo, maybe like she's not getting it all out each time, or maybe she's just trying to poo when there isn't one ready yet). She didn't used to drink much when younger and did have harder poos sometimes then, but she has always eaten shedloads of fruit and it would usually be one day of dryish poo, then we'd give her kiwis or something similar, and more to drink and it would resolve.

So my question is, does this sound like a need for disimpaction, or more likely something else? If we try a disimpaction and that isn't the issue I assume we just get runny poo water fairly quickly and nothing else happens? How would we know?

What are the options for getting a scan done first to see if impaction is actually the issue, or something else is? Worth my trying to push for this, or unlikely to happen in reasonable timeframe on NHS?

And if that is the issue, would the wetting resolve pretty much immediately after the blockage is cleared, as bladder would have space to expand again, or would it only resolve when bowel has gone back to correct size?

And anyone have any other ideas what might be going on, or how to figure it out?

We have a Dr's appointment booked to discuss, but I have a feeling they're not going to be very helpful (based on conversations with them on this to date) so I'm looking to be armed with as much info as possible in advance!

[Yaleamanda]

In the main it looks like you have answered most of your own questions with the correct answers. I would add though, how much is she drinking during the day, when she goes does she fully void, get her to sit for further 30 seconds, you will be surprised how much more wee comes out. Unfortunately, getting a scan or xray to rule out impaction is near on impossible in children, however, should you wish to disimpact and she isnt impacted then it wont take too long to get to the disimpaction if done correctly. It is common for children to be impacted and it go unmissed as parents think they go regularly and the stools look fine when in fact they are completely backed up. Unfortunately due to her age you may find it hard pushed to be referred to the local continence team, but it is worth a try as they will be able to help you with this, they are much better trained in this than Drs. Just to add, if she is impacted, the wetting may take a while to settle down as the bowel will have stretched over time and it can take a while to go back to it's original size which is why it is important after a disimpaction to remain on a maintenance dose of osmotic laxative to keep things nice and soft.

[AtoZtoA in reply to Yaleamanda]

Thanks - she has 5-6 drinks a day of 100-150ml each. Sometimes more / bigger. Only drinks water or milk but also eats lots of juicy fruit and her wee is pretty pale / colourless most of the time so I think she's getting enough liquid. We used to do 60-100ml cup sizes, but upped it around 6m ago as realised that was probably too small. I know recommendation is 6-8 and probably around 150ml for her age, but the days she has more drinks / bigger cups it just goes straight through her (in multiple high frequency wees) which just annoys her (and me!) so I'm reluctant to increase any more til we know what's going on.

We've tried to encourage double voiding but don't tend to get any out the second time (though that may be behavioural... It can be hard to disentangle the two sometimes as she is v strong willed and hates it when she thinks she's done something 'wrong' which I think is how she interprets it when I ask her to try again for any leftover wee after she's just been)

[Teddy500]

I would try the ERIC helpline and website, best wishes 🦋

[Melburs]

Everything you have said was my daughter. She did improve with age a little but the doctors referred her to paediatrician at 6. At 7 years old I’m still waiting for scan as it’s a service impacted by COVID. However they have prescribed her meds which has solved the problem. I got fobbed off by doctor for a while saying she may grow out of it, however I didn’t have all the info you have gathered so take your wee info and see what they say. We used an alarm at night with success to get her dry. No drinks after 5 but she was 6 years old. The alarm might be hard with little one. By 6 my daughter wanted to solve it!!! However the poor thing still had to get up for a wee every night she just woke up to do it rather than going in her nappy. Before 6 she was having 2-3 weeks a night. I was worried sick about her daytime wetting and starting school. She’s august child and I thought about holding her back a year. In the end I didn’t and honestly the schools just dealt with it and she is doing so well at school. Had to tell every teacher to let her go to toilet straight away!!! I hope you get referred as it does sound like overactive bladder xxx

[Melburs in reply to Melburs]

Forgot to add, my daughter has no poo in her bowel and movocol did not help wetting issue for her. The scan is to assess her bladder and capacity xx

[AtoZtoA in reply to Melburs]

Thanks - and glad your daughter is doing better now. I'm not bothered about night times at the moment (though no doubt that time will come!) but an improvement to daytime would be most welcome! Will see what the Dr says...

[Melburs in reply to AtoZtoA]

Good luck, I hope they help. I knew from when my daughter was little it wasn’t quite right (she’s my 3rd), but still had to wait until she was 6 for referral 😢. However you have so much info I hope they take your concerns seriously. My daughter just got used to going to the toilet all the time, poor thing. We always had spare clothes. She understood she could only drink water etc xxx. She confided in a couple of her friends at school and got through it, although as she got older she did get frustrated with herself xxx

[Starryeyes2000]

It sounds like you are doing all the right things to gather information. My daughter has an overactive bladder and a neurogenic bowel. Once her bowel was cleared out, we did see improvements in her bladder symptoms. She is also on medication for her bladder which has reduced her symptoms also.

The bladder diary is good. Staying on the toilet for a little longer after a wee is sensible, double voiding at bedtime. Some drinks and food can be triggers to agitating the bladder, my daughter’s trigger is tomatoes.

As she’s only little, you might get told not to worry about it, but with the info you have, I’d see if you can get a referral. Best of luck xx