Toileting, Bowel and Bladder

Constipation is a problem for 1 in 3 children. It commonly starts around the potty training stage and can also affect babies.

It is a medical problem that needs treating properly to stop it getting worse. Constipation won’t go away by itself.

Common constipation symptoms in children include:

• Doing fewer than 4 poos in a week. Ideally, children should pass some soft poo every day, or at least every other day.
• Pooing more than 3 times a day. This can show that their bowel is full, and poo is leaking out a bit at a time (soiling). It might be hard bits of poo, soft or even liquid poo called overflow.
• Poo that looks like little pellets or rabbit droppings.
• Big poos, or lots of poo all at once.
• Pain when they poo and needing to strain. There may even be some bleeding when they poo or afterwards. Hard, large poos can cause an ‘anal fissure’ or small tear in the bottom.
• Having a swollen, painful tummy. They might not feel like eating, or even feel sick.
• Smelly poo, wind, and bad breath.
• Bladder problems such as doing lots of small wees, needing to wee urgently, bedwetting and urinary tract infections.
• Difficulty with potty training including children who refuse to poo unless they are wearing a nappy.

The best way to get rid of constipation is to treat it as early as possible. The longer it's left, the harder it will be to treat.

Here's what to do next if you think your child is constipated:

• Use our poo diary to keep track of their bowel habits for a few days.  Record what their poo looks like using the Poo Checker, how often they're going and if they're in any pain.
• Book an appointment for your child to be seen by your GP. Take the poo diary with you.
• The doctor should examine your child and check to make sure the constipation hasn’t been caused by an underlying condition.
• If your GP diagnoses your child with constipation, they need to follow the treatment pathway as recommended by NICE Guidelines.

Constipation is not a problem that can be helped by a change in diet only or waiting for your child to ‘grow out of it.’

Soiling is when bowel movements happen in places other than the toilet such as underwear or pooing in the bath. It can be a really upsetting problem for children and their parents to deal with.

There are lots of myths about bowel incontinence in children. Soiling is not caused by laziness or naughtiness. Children don’t have a leaky bum because they are looking for attention or just can’t be bothered to go to the toilet.

The advice for treating soiling is the same as relieving constipation in children.

Your child needs to be seen by a GP who can prescribe laxatives to clear any lumps of poo.

For more information about treating soiling, see our advice for children with constipation. It explains how laxative treatment and a toilet routine can help a child who is soiling.

Bedwetting (enuresis) is a medical condition which should be treated in children from age 5. Around 15% of all 7 year olds regularly wet the bed. Bedwetting is a medical condition which is nobody's fault.

There are three main reasons for children’s bedwetting:

• Their bladders don’t stretch enough to hold all the wee they make at night.
• They produce too much wee at night.
• They don’t wake up when their bladder sends a signal that it’s full.

There can be underlying health conditions causing your child's bedwetting which need to be ruled out and treated if necessary.

Underlying causes of bedwetting include:

• Constipation – if your child's bowels become blocked with hard poo, it can put pressure on the bladder and lead to bedwetting. Read about the signs of constipation and how it needs to be treated.
• If your child has daytime bladder problems, this needs to be investigated by a healthcare professional first.
• A urinary tract infection (UTI) can make your child’s wee painful, causing frequency and urgency in their bladder.
• Type 1 Diabetes. Alongside bedwetting, other symptoms of this can include feeling thirsty, frequent weeing, weight loss, hunger, blurred vision, tummy pain, vomiting, thrush and tiredness. You must take your child to the doctor if they have these symptoms to be tested.

When children have an additional need or physical disability, it's important their bedwetting should be assessed as it may not be related to their existing condition(s). The evidence shows the sooner your child is assessed and treated for bedwetting, the better chance they have of becoming dry at night.

NICE guidelines recommend that all children still bedwetting over age 5 should be given a bladder and bowel assessment by a healthcare professional. Contact your GP for an appointment. There may be a bedwetting or enuresis clinic in your area that your child can be referred to.

Things to do before your appointment:

• Check whether your child is drinking plenty during the day and what they're drinking
• Make sure they are emptying their bladder before they go to sleep
• Complete a night-time diary to record wet and dry nights
• Keep a poo diary if you think your child is constipated

Almost all children can learn to be clean and dry. Children with special needs including delayed development and physical disabilities may take a little longer and need more support.  Your child may take longer to learn each stage, so consider your expectations and don’t rush the learning.

• Focus on one stage at a time. For example, teach them that poo goes down the toilet by flushing it away together.
• Be as consistent as possible. The more consistent you are, the easier it will be for your child to learn.
• It’s important that your child feels relaxed, comfortable and secure about using the toilet or potty. Make sure the space is accessible to your child. An Occupational Therapist (OT) can help with practical adaptations.
• Think about your child's sensory needs and how these relate to using the bathroom. Adjusting the sensory input can make a difference for many children to help them to learn toileting skills.
• If you start with the toilet you should use a footstool to help your child feel confident and safe. This will also help your child get into the best position for doing wees and poos, with their feet supported and knees above hips.
• Help your child learn the physical skills needed by breaking them down into smaller steps and allowing your child to do the last step independently. For example, help them push their trousers down most of the way, then have them push the last bit down themselves. Same when pulling them up again.
• Encourage independence as soon as you see it developing, phasing out support once your child shows competence.
• Use stories, visual charts, props and games to teach your child what to do and how to do it. Make your own learning aid by taking photos of your bathroom, drawing pictures of the steps, or by searching on the Internet for visual routines. A standard routine could be: 1.Undress 2. Underwear down 3. Sit 4. Do wee/poo, 5. Wipe, 6. Pull up underwear, 7. Pull up trousers/dress, 8. Flush toilet, 9. Wash hands.
• Give your child positive encouragement and praise for the efforts they are making, not just the result. This can help to keep them motivated and willing to move to the next step.