Toilet Training Problems Could Be Physical

Many negative behaviors related to young children’s toilet use result from physical problems that can be easily identified and resolved by your pediatrician. Certainly, physical causes are the first possibility to investigate when your child seems stuck in a negative behavior and unable to find a way out.

Such was the case with Lindy. After talking briefly with Lindy’s parents and then the four-year-old child herself, and giving Lindy a brief physical examination, her pediatrician concluded that the minor leaks she experienced were due partly to a physical problem (somewhat weak bladder muscles) and partly to a temperamental one (she was often so impatient to get off the potty and back to her play that she failed to empty her bladder completely, causing the last drops to leak into her underwear later). Though leaks hadn’t been a problem before Lindy started preschool, her more focused, intensive school routine caused her to rush her bathroom sessions, and her bladder muscles were unable to hold in the remaining urine between visits.

Her pediatrician prescribed a series of exercises (called Kegel exercises) that Lindy could do to strengthen her muscles, advised her parents to encourage her to slow down and enjoy her time on the potty, and suggested to Lindy that she stay on the potty for a few seconds after she thought she was done. He also recommended talking with Lindy’s teachers about this issue so that they could monitor Lindy’s bathroom practices and set up a schedule that ensured frequent visits.

Your own child may experience frequent dampness or leaks for quite different reasons—say, a small bladder capacity that requires her to void more frequently than she’s willing to; a “lazy bladder” that leads to voiding only once or twice a day, with overflows at other times; lack of coordination between the bladder muscle and the sphincter (the ringlike muscle involved in controlling bowel movements); insufficient exercise, leading to poor muscle control; or even emotional stress, which can create irritation of the bladder walls.

Some of these situations, such as small bladder capacity, will probably soon be outgrown. Others, such as poor muscle coordination, can be remedied through biofeedback and, possibly, prescribed medications. Some may require changes in other aspects of your life, such as instituting a regular schedule of bathroom visits or reducing the stress that is affecting your child’s functioning.

Your pediatrician is the best resource in creating the right combination of medication, behavior modification, and other treatment for your child. He can also identify or rule out such serious conditions, indicated by increased frequency of urination, as diabetes, urinary tract infections, or neurological problems.

Finally, he can help identify nonphysical causes of incontinence, including poor bathroom habits—for example, a girl’s urinating while holding her legs together, thus retaining urine that leaks out later. Other nonphysical causes may involve such normal aspects of child development as testing parental boundaries, overfocusing on other activities and ignoring the body’s signals, or having difficulty verbalizing fears, anxieties, and physical discomfort relating to bathroom use.