Bowel and bladder incontinence in a 5 year old

[Littleoak93]

Hi, I would love any advice that can be offered please regarding my 5 year old son and his incontinence issues. I'm at a loss really with what to do next at the moment. He has a mild developmental delay and was 3 and half years old when he was toilet trained. He is having regular wetting incidents at home and at school currently. It seems like he is holding his wee in and will have a wet patch in his pants or fully wet himself before going to the toilet. He is always needing constant reminders to go to the toilet. He is also having a lot of soiling issues. We try to get him to go for a no 2 every morning after breakfast. If he does go then we may not have an incident at school, but it is still possible he will go again at school. He will not tell them he needs to go to the toilet and will soil or wet himself. Often this means that he would not have fully gone and will then have several more accidents due to stopping and starting. His stools will also often be loose . I've considered constipation but wondered if it's possible as he usually goes at least once a day and is quite regular. I've also considered if he could have a food intolerance as they seem to become more loose after dairy products. I just can't work out if this is behavioral or if he is simply not getting the signals or there is a medical issue. Any advice would be gratefully received! Thank you!

[Yaleamanda]

Sounds like he is constipated and witholding, hence the soiling accidents. The wetting is most likely to be happening due to a full bowel pushing on the bladder. Encourage regular toilet sits after every meal and dismpact him (have a look at the Eric website on how to do this).

[Littleoak93 in reply to Yaleamanda]

Thank you for your reply. I am wondering this although I'm surprised he could be constipated considering how regular he is and how much he goes each time!

[Yaleamanda in reply to Littleoak93]

Just because they go regularly and with great amounts does not mean they are not backed up.

[Littleoak93 in reply to Yaleamanda]

Thank you.

[Hidden]

It’s often constipation but not always.

We discovered our daughter was lactose intolerant this time last year, it was a similar situation with days of multiple loose stools, sometimes with bits of undigested food. Additionally we no doubt started toilet training too early after pressure from nursery, and she also gets very hyper focused on what she’s doing and finds it hard to self initiate changing activity. That might be a neurotype thing - I recently was diagnosed ADHD myself and we’re on ADHD watch for her (though at 5 she’s too young to call it). There was maybe a developmental lag for interoception. I also wonder whether there’s a degree of IBS.

Whilst sorting out the food intolerance didn’t solve the problem, it helped us get into a place where we could work on the other stuff and she could feel her bowels were more predictable. And honestly, for our individual child, I think that trying laxatives would have made the situation worse. A year on we’re not out of the woods but she’s doing good firm stools usually daily, can definitely notice the need when not distracted/when already transitioning activities/when cued, and the remaining thing we need to work on is her stopping what she’s doing to poo.

Do you have a good GP to discuss all of the different aspects with abs problem solve together the likely issue/s? Our surgery gave me an appointment with one with a special interest in paediatrics.

[Littleoak93 in reply to Hidden]

Thank you for your detailed reply, it's really interesting to hear your perspective from a parent of a child with a lactose intolerance. I have also wondered about the developmental lag. I think we may have to go down the process of elimination to work out exactly what's wrong.

[Hidden in reply to Littleoak93]

What we did was initially cut out all dairy until things stabilised, then on advice from a paediatrician we started the milk ladder for lactose free dairy products (all fine), then started again with lactose containing products (biscuits seemed fine but step 2, which I think was a doughnut, was not ok). We do need to try again at a later date but we’re trying to get the other stuff sorted first.