Many children and young people experience bladder problems, but these are often poorly understood. They may be associated with behavioural difficulties or emotional problems but are rarely caused by them. It is more likely that any behaviour and/or emotional issues are the result of the bladder problems. Often these reduce or go away when the underlying bladder issue is treated.

Understanding bladder problems in children and young people

To understand the causes of many bladder problems, it helps to understand how the bladder works. The bladder wall has a layer of muscle in it that should reman relaxed, soft and stretchy while the bladder is filling. There is also a circular ring of muscle at the base of the bladder that should remain contracted (squeezed so it is closed) during bladder filling.

The kidneys are constantly producing urine and it is collected in the bladder.  When the bladder is about half to two thirds full it should start to send messages to the brain to alert the individual that they are going to need to use the toilet. As the bladder continues to fill those signals become stronger. Young children who have not been toilet trained for long, may need the later stronger signals to notice that they need the toilet and are therefore less able to wait to pass urine. However, if the bladder is working correctly, older children will become aware of the signals earlier so have more time to get to the toilet.

When the individual goes to the toilet, a complex control mechanism allows the bladder wall to know it is time for the muscles to tighten and squeeze to push the urine out. At the same time, the circular muscle at the base of the bladder relaxes and opens to allow the urine out.  The bladder can then fully empty before the bladder wall relaxes again and the circular muscle contracts and closes the bottom of the bladder. This mechanism allows us to pass urine in a socially acceptable time and place.

While there are different underlying causes for bladder difficulties in children and young people, for most there is no problem with the way the bladder has been constructed. The most common bladder condition in children and young people is called bladder overactivity.

Children and young people with an overactive bladder often appear to leave it to the last minute to go to the toilet. Adults may understandably perceive this as laziness, naughtiness or the child being too engrossed in what they are doing and leaving it too long.  However, ‘urgency’ to get to the toilet is usually caused by the bladder wall contracting (twitching or tightening) suddenly and unexpectedly before the bladder is full.  This happens with no warning and results in an unexpected and urgent need to get to the toilet. If the circular muscle at the base of the bladder recognises that the bladder wall is tightening, it may respond by relaxing and urine may then leak.

The urgency may be associated with frequency, which is the need to pass urine more than seven times a day in children over four years old . Additionally, children and young people with overactive bladder may have bladders that hold less urine than is expected for their age and physical size. This is because the bladder is used to emptying more frequently than it should, so it is never holding as much as would be expected if the bladder were working well.

Many children and young people who have this problem will ‘dance’, fidget, hold their groin or suddenly crouch and put their heel into their perineum.  They are often unaware of what the are doing and if asked if they need the toilet will usually say no.  They will usually then try to get to the toilet quickly just a few minutes later.   This is because the movements that adults recognise as an indication that the child needs the toilet appear to be subconscious in the child.

Did you know an overactive bladder can occur at night?

Bladder overactivity can occur at night as well as during the day. If it does the child or young person may wake more than once a night to use the toilet. If they are unable to wake to bladder signals they may have bedwetting. Overactive bladder is a common cause of bedwetting.

The reason why an individual has developed overactive bladder may be unclear. It can happen as result of a previous urinary tract infection and it is commonly associated with constipation. However, the problem does not always go away when the urinary tract infection or constipation has been treated.

Many children and young people with bladder issues respond by reducing their fluid intake in the hope that drinking less will make the problem better. Unfortunately, strong urine can irritate the lining of the bladder and make the problem worse. Fizzy drinks and ones with caffeine in can also irritate the lining of the bladder.

Assessments for children and young people

Children and young people who are experiencing problems with bladder leakage, frequency or urgency should be offered an assessment of their bladder and bowels to try to work out the cause of the problem and identify the appropriate treatment for them. If constipation or a urinary tract infection is present, this should be treated.  Ensuring that children are drinking plenty of water-based drinks each day is also helpful for many.  Primary school aged children should be having about 1.5 litres of water-based drinks a day; teenage girls should have about 1.5-2.5litres a day and teenage boys should have about 2-3litres a day. Regular toilet visits may also help. However, many children do need specialist assessment, support and medication.

Where can I find more information?

If you are a young person with a bladder or bowel problem, or parent of a child with an issue, then do speak to the GP or school nurse, who should be able to provide more support or referral to an appropriate service.

For more information about bladder and bowel conditions visit the Bladder & Bowel UK website or our children and young resources page.

For general advice and support please complete our Bladder & Bowel UK confidential helpline enquiries web form.

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World Continence Week 2020

It is estimated that over 20 million people in the UK have some form of bladder and/or bowel problem. Due to embarrassment and social stigma these are not often discussed. This leads to the belief that bladder and bowel problems only affect very young children, women after childbirth and the elderly. This is not the case. They can affect anyone of any age, including children and young people. However, World Continence Week was started in 2008 to encourage people to talk about bladder and bowel issues and to seek help. At Bladder & Bowel UK we offer support and advice to anyone experiencing a bladder and/or bowel issue.

What problems do lots of children and young people have?

• Constipation with or without soiling. Constipation happens when someone is not able to fully empty the rectum (the bit of bowel closest to the bottom). The poo then builds up, becoming larger, harder and more difficult to pass. When it is eventually passed this may cause pain, which makes younger children reluctant to want to poo again, which may cause the constipation to continue. For older children, not being able to go to the toilet as soon as they need to, or a lack of privacy at school may make the problem worse. If a lot of poo builds up in the rectum this can result in poo leaking into the underwear. The child or young person is not usually able to control this and is often not aware it is happening.
• Day time wetting. Leakage of urine (wee) into the pants can happen at any age and for a variety of reasons. One of the commonest causes is constipation – the full bowel puts pressure on the bladder, making it difficult to get to the toilet on time. Other causes include urinary tract infections and problems with the way the bladder muscle is working.
• Occasional bedwetting is very common in younger children. Wetting most nights is less common, but is very unlikely to improve without treatment. It may continue into adolescence and even into adulthood if left. There are a variety of causes of bedwetting, including constipation, a bladder that is not working as well as it should, or not being able to reduce the volume of urine that the kidneys produce during the night. Children and young people who wet when they are asleep are unable to wake up to the signals from the bladder that it needs to empty.
• Delayed toilet training. Some children take longer to toilet train than others do. This is particularly true if a child has additional needs. However, most children can learn all the skills they need to toilet train, if they are given the right help and support.

What other bladder and bowel problems can children and young people have?

• Some children are born with conditions that affect their bladder and/or bowel. If there has been a problem with the way the spine has formed in pregnancy, then the nerves that supply the bladder and bowel may have been affected, which in turn, can cause difficulties with bladder and bowel continence. If the bladder or bowel has not formed properly then this may result in problems with continence. Some children require surgery to help. Some may need to use special equipment, such as catheters or bowel irrigation, to help them stay clean and dry
• If a child or young person has had an accident or illness that has affected the nerves in their spine, this in turn may affect bladder and bowel control.
• Inflammatory bowel diseases such as Crohn’s Disease and ulcerative colitis may affect children and young people. These may cause pain, diarrhoea, blood in the poo and the child or young person may not have much energy.
• Irritable bowel syndrome may affect children and young people. It can cause stomach ache, diarrhoea or constipation

Is there treatment for bladder and bowel issues in children and young people?

Treatment or help is available for all the conditions that children and young people experience.

Children who have been born with a problem that affects their bladder and/or bowels are usually offered support and help from birth or shortly afterwards and are usually followed up by the hospital where they have received their initial care.

For children who do not become clean and dry at the usual age of toilet training, for those with additional needs and for those who develop problems after toilet training there is also help and support available. Therefore, if you are a young person with a bladder or bowel issue, or are a parent or carer to a child or young person who has a bladder and/or bowel issue, then do ask for help and support.

How do I get help for a child or young person with a bladder and/or bowel issue?

For most people, the best person to speak to is the child or young person’s GP or other healthcare professional. For children under five years old then the health visitor should be able to support. For children of school age, the school nurse could be approached.

For young people, most school nurses offer a ‘drop-in’ service at secondary schools. The school reception should be able to tell you when your nurse is available. You do not need to tell the reception why you want to see the nurse. Young people may also ask for a GP appointment themselves and you can ask to be seen on your own. If your GP is happy that you understand the options open to you they can offer treatment without your parents or carer being there, but they will probably encourage you to speak to them. Once you are 16 years old you may register yourself with a GP.

Is help available anywhere else?

Bladder & Bowel UK have lots of information and resources on our website at www.bbuk.org.uk to support people of all ages with bladder and or bowel difficulties. These are all free to download and print.

Bladder & Bowel UK also have a confidential helpline staffed by children and adult nurses who are specialists in bladder and bowel care. You can contact them by email at bbuk@disabledliving.co.uk or by telephone on 0161 214 4591.

Tag us in your World Continence Week tweets @bladderboweluk.

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The team is made up of four specialist nurses, two adult and two paediatric, who have a variety of backgrounds, experience and skills in the specialty and an Information Coordinator who has a wealth of knowledge around products and services available. The team is based in Manchester but travel all over the UK as all roles are national.

Key activities within the team on a day to day basis are:

• Providing clinical and product access via the national, confidential helpline to individuals, families and other health care professionals.
• Providing specialist education to nurses and carers within the NHS, care home sector and other independent sector.
• Hosting national study days and company exhibitions.
• Attending exhibitions and conferences promoting continence and Bladder & Bowel UK services
• Providing education and guidance to healthcare companies, both medical device and pharmaceutical.
• Writing articles and clinical literature promoting good practice, correct usage of products and tips for self management.
• Working with the healthcare industry to advise on product development, innovations and services to patients.

…and that’s just to name a few!

If you would like to know more about us or find information to promote your bladder and bowel health, please visit our website. You may decide to have a read of our resources, ring the helpline or book on one of our study days. Either way enjoy!

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Men, women and children can all be affected but many suffer in silence because it is not a topic that is openly discussed. This is true even today in the world of social media where individuals share a lot of information bladder and bowel issues are not openly discussed.

Common bladder problems include urgently needing to pass urine, bladder leakage, bed wetting or difficulty emptying the bladder. Common bowel problems may include faecal leakage, constipation and difficulty emptying the bowel.

Continence problems can cause embarrassment, anxiety and distress and often has a significant impact on an individual’s quality of life.

It can be difficult to discuss symptoms but it is important to know that help and support is available and the choice of treatments and management options has never been greater. With the right interventions symptoms can often be significantly improved with a positive impact on quality of life. Interventions may include lifestyle changes, pelvic floor exercises, medication or possibly surgery.

Most areas within the UK have specialist services that can provide excellent clinical care and many accept self referrals so no need to see a GP first. These are usually called the Continence Service or Bladder and Bowel Service.

If you need advice on where the local service is based consult your GP or contact us at Bladder & Bowel UK on 0161 214 4591. You can also find us on Twitter and Facebook.

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Bladder and bowel problems among adults are not uncommon, affecting both males and females of all ages. Some common bladder problems may include bladder leakage (incontinence), bedwetting or difficulties emptying the bladder. Some common bowel problems may include leakage (faecal incontinence), constipation and difficulties emptying the bowel. 

Having a bladder or bowel problem (or both), can cause embarrassment, anxiety and distress, often having a major impact on an individual’s quality of life. Often people are reluctant to discuss their symptoms with anyone. But it’s important to know that much can be done to treat, manage and improve symptoms. It’s important to discuss any problems with local healthcare professionals to ease the taboo around this subject. World Continence Week 2018 gives everyone an insight into seeking help, talking more openly about problems and raising the profile of services that can help.

Experiencing bladder and bowel problems can affect an individual in many ways including social, psychological and financial. Many feel that they can’t take part in hobbies and sport any longer. Some people will avoid social occasions due to self esteem issues and embarrassment.

Advice, support, and practical help

Here at Bladder & Bowel UK, we can offer advice, support and practical help to individuals who are experiencing problems alongside their families, carers and healthcare professionals. Advice is available from adult and child Specialist Nurses.

There are several types of urinary incontinence. But the most common types include stress incontinence, (leaking on coughing, exercise or sneezing), urgency or dashing to the toilet, urge incontinence, mixed incontinence, overflow incontinence, difficulties emptying the bladder and functional incontinence.

Other bladder problems that do not involve leakage can include the need to pass urine frequently, urgently and an increase need to pass urine during the night.

Bladder & bowel problems in childhood and young people

Bladder and bowel problems in childhood and young people are very common. Problems including difficulties with toilet training, wetting, constipation and/or soiling affect up to 28% of all children and adolescents at any one time. Younger children are affected more often than older children. But problems can happen at any age. Parents or carers often feel as if their child is the only one suffering, as nobody talks about it.

We can also suggest how to approach your child’s GP, health visitor, school nurse, or other healthcare professional for treatment if appropriate. They should be able to offer individual assessment and treatment or refer you to a specialist for this, if necessary.

Bladder problems affect children and young people of all ages. The commonest problem is night time wetting. However, children and adolescents can also be affected by wetting during the day, having to rush to get to the toilet (urgency), or having to go to the toilet more often than is normal (frequency) or a combination of any or all of these. Less common problems include urinary tract infections (UTI).

Initially it can be difficult to understand why a child or young person has a problem with their bladder and sometimes parents or carers might think it is a behavioural problem, or that their child is being lazy.

Most children are dry in the day by the time they are three-years-old and at night by the time they are five. If a child has additional needs, it may be thought any delays in achieving dryness are related to the disability. However, all children with daytime wetting, frequency, urgency or any bladder difficulty should be offered an assessment and treatment if appropriate.

How can Bladder & Bowel UK help?

Helpline services including signposting to local specialist services, product advice, generic clinical advice and support.

How can we be contacted?

The helpline is available Monday to Friday, 9.00am – 4.00pm on 0161 214 4591. We are also contactable by email: bbuk@disabledliving.co.uk.

So, who contacts us?

Anyone concerned by a bladder or bowel problem may contact us for help and advice. This includes the general public, relatives, carers, health and social care professionals and other groups such as teachers or organisations such as charities and support groups.

Duration of calls we receive?

We receive a large number of calls each day to both the helpline or via our email service. Enquiries range from a quick question being answered. But more often are more detailed, requiring us to dedicate time with the caller, to go through their concerns or query.

Why do people contact us?

We are contacted for a number of reasons. Some request information on continence products, aids and appliances. Some are looking for local bladder and bowel services and are surprised when we inform them that things can be done to treat, improve or better manage their situation. We always try to suggest that people present for continence assessment and to signpost or put people in touch with their local services, so they can access the help they need locally. We may also signpost to other charities or organisations. Health and social care professionals may be looking for information or training, which we also provide.

We always try to ensure that people accessing our services are informed and directed to other appropriate services, such as NHS specialist bladder and bowel services for further help.

We always encourage an individual or family member to speak to someone, GP, Continence Specialist Nurse, District Nurse or other healthcare professional.

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General suggestions for travelling with a continence problem:

• Contact the airline or travel company to discuss your individual needs before booking/travelling.
• Think about what you need to carry with you, such as medicines and products. You may need to have a letter from your doctor to be allowed to carry them through security.
• Contact the transport operator before you travel, if you are worried about luggage or body searches and possible exposure of your continence products.
• Ask the operator if you can board early, to ensure you have time to get settled with everything you may need during the flight easily accessible

Disposable continence pads while travelling

• Disposable pads can take up a lot of space. Consider trying more absorbent pads so that you need to take fewer of them, or smaller pads that take up less space.
• Make sure you obtain the products you are going to need for your trip well ahead of your travel date.
• A vacuum pack bag can help to reduce the amount of space pads take in your luggage.
• Consider using other products e.g. Men could consider using a sheath instead. Booster pads inside your usual product may increase absorbency for long journeys and could be removed part way through the journey.
• Would you be able to manage washable products while away? These take up less space.
• Ask your product provider whether they are able to deliver direct to your holiday destination, or send a supply ahead yourself, but take some in your luggage, in case there is a problem and they do not arrive.
• Ensure you have some spare products in your hand luggage while travelling in case your main luggage is lost or delayed and divide your pads between your luggage and that of a travelling companion if you are happy to do so
• Contact the airline to see if there are luggage restrictions or if continence products would be exempt as are some other categories of equipment, such as wheelchairs. Remember you will have less to bring home with you as most of the pads will have been used.
• If you are worried about leakage, consider having a chair protector for the flight
• Consider the climate of where you are travelling. Dampness can affect the absorbency of pads; heat can affect the adhesive tapes, for example on sheaths.

Catheters

• Catheters are not the right option for everyone, but might be easier to manage on a flight. Consider discussing with your healthcare professional whether this would be an appropriate or safe option for you
• An indwelling catheter might be an option during travel for someone who usually uses intermittent catheterization

Managing catheters on flights

• Consider having a urinal, such as a uribag to empty catheter bags into. A travelling companion can then take it to the toilet to empty this for you.
• Ensure that you carry spare catheters, bags and any other equipment you may need with you.
• Ensure you have some spares, in case of delays etc
• Divide your catheters and supplies between your hand and hold luggage and consider giving some to a travelling companion, in case of luggage delay or loss
• Have hand sanitizer and wet wipes in case access to a sink and soap is limited
• Obtain a medical validation or travel certificate from your catheter provider. It will explain in different languages why you are carrying catheters and also has a section urging officials to be discrete
• Consider using ready-to-use hydrophilic catheters if you are travelling in countries with poor water quality

Accessing the toilet

• Try to book a seat near the toilet and on an aisle.
• Consider using a pad inside close fitting underwear, in case you cannot get to the toilet quickly enough.
• Think about taking wet wipes with you and having a small bag with one change in it and easily accessible throughout the flight.
• Consider using a urinal or urine director if you struggle to move easily
• Be aware that you may become a bit numb if you are sitting on the plane for a long time and plan a toilet visit for a set time, even if you are not sure you will need it then.
• Be aware that some people find that they are more likely to leak larger amounts of urine when the plane starts to descend. Consider planning a toilet visit just before that time.
• If you are not sure what the toilet facilities are like at your arrival airport consider a toilet visit before decent begins and access to toilets on board is restricted.

Clothing

• Wear clothing that is comfortable and easy to rearrange when accessing the toilet while travelling with a continence issue. Elastic waists, drop front pants (ones that have poppers or Velcro on the side seams can be easier to manage.
• Dark coloured clothing makes leaks less visible.
• Loose fitting clothing is easier to remove. Consider having a spare set of clothing  and a plastic bag in your hand luggage in case of leaks.

Fluid intake

• Ensure that you drink enough. Plenty of water will prevent dehydration, help to protect   against urinary tract infections and ensure that urine remains dilute. Concentrated urine can irritate the lining of the bladder and increase wetting.
• Avoid tea, coffee, hot chocolate and alcohol. All of these increase urine production.
• Avoid fizzy drinks as these can irritate the ladder lining.

Bowel issues

• Try to stick to your usual diet routines when travelling to avoid feeling bloated, nauseous or uncomfortable. Digestion and body clocks can be upset by crossing time zones.
• Try to move as much as you can, particularly on long flights. This will help with both circulation and digestion.
• Discuss with your health care professional whether an enema or suppository a few hours before the flight would be an appropriate way for you to try and avoid a bowel motion during the flight.

Additional information

If you have further questions or any concerns, then contact your health care professional. Bladder & Bowel UK can also offer confidential support, information and advice. Contact us by email at: bbuk@disabledliving.co.uk or by visit our helpline.

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The summer is upon us and with it a whole host of national sporting events; The World Cup, Wimbledon and the Open to mention a few. There will be some professionals taking part in these major events who will be experiencing bladder or bowel problems, as these are often a hidden problem and rarely visible to others.

Sport is such a brilliant way of maintain physical fitness and well-being alongside, in many cases, having a pleasurable and social aspect. However, how many people experience bladder and bowel problems that affect their participation in sport? Some people, especially ladies but some gents, experience stress incontinence during exercise which can affect their motivation for taking part due to embarrassment and discomfort. It is, also, true that many who never experience incontinence but may experience for example urinary urgency or constipation are restricted by their bladder and bowel conditions when considering participation in sporting activities.

Lifestyle activities

It is essential as part of an overall holistic continence assessment to ask about lifestyle activities, current and any that maybe the individual does not feel able to be part of any longer. It may be a post natal lady who has stopped her aerobics class due to stress incontinence. Through proactive management, advice and support individuals can get back to sports and hobbies they like or seek alternatives when functionality of the bladder, bowel and pelvic floor are explained. It is advisable for anyone experiencing pelvic floor muscle weakness to switch from a high impact sport to a low impact sport. Advice should, also, be given on how to prepare for sporting activities to prevent discomfort, leakage etc during the activity.

Maybe some individuals prefer to be spectators of sport and this activity can, also, be affected by bladder and bowel problems as it may mean not been close to a toilet or lack of public toilets and facilities. Bladder & Bowel UK has produced a ‘Just Can’t Wait’ card that is available to individuals who feel they need to access toilets urgently, frequently in the absence of the availability of public toilets.

Promoting support and advice

We need to be as proactive as possible as continence professionals in promoting support and advice as much as possible to enable continuation of positive involvement in sport for those who want to take part and those who enjoy watching sport. Encourage individuals to seek help to enhance quality of life to continue and return to a sport they enjoy!

Let’s hope the sportsmen and women from the UK do us proud!

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What is the meaning of the word continence?

It comes from a Latin word that refers to control. It is used to describe control of bladder and bowels.

Who can be affected?

Continence problems can affect anyone – children, young people, adults and older people. However, due to embarrassment it can be difficult for those affected or their carers to talk about these problems and to ask for help.  Continence problems are often treatable.

Are there any helpful tips for maintaining continence?

• Drinking water based drinks – about 1 ½ – 2 litres (6-8 glasses of water) is the right amount for most people. This helps to prevent constipation and keeps the bladder healthy. Drinking too little can make continence problems worse.
• Avoid fizzy drinks and drinks containing caffeine
• Avoid alcohol
• Avoiding constipation and treat it if it develops
• Pelvic floor exercises can prevent and reduce leaks for both men and women, but you may need to do these for several weeks before things start to improve. More information is available from your Health Care Practitioner.
• Do not smoke – coughing strains the pelvic floor muscles and can increase the likelihood of leaks
• Pilates and other similar exercise can strengthen pelvic floor muscles
• Maintain a healthy weight. Being overweight can increase the pressure on the bladder and pelvic floor muscles

What foods would/wouldn’t you recommend to help continence?

• Spicy and acidic foods might irritate the bladder and make incontinence worse.
• Avoid very salty or high protein foods before bed, as these increase the amount of urine that your kidneys make, so you will be more likely to have to wee overnight.
• Fruit and vegetables and foods containing fibre can help prevent constipation and therefore improve incontinence.  However you need to drink plenty of water if you are eating cereal-based high fibre foods

Is there are cure or any treatments available for continence?

There are lots of different causes of incontinence and there are also many different treatments available. Therefore, if you or someone you care for suffers from incontinence see your GP or health care practitioner to discuss the problem. They will either undertake an assessment or refer you for one, so that you are offered the right treatment for you.

What support is available from Bladder & Bowel UK?

Bladder & Bowel UK is a national charity that provides information, advice and support to people who have bladder and bowel problems, to their carers and to professionals who work with them.

More information is available on Bladder & Bowel UK website. You may contact us by email: bladderandboweluk@disabledliving.co.uk or by phone on 0161 214 4591.

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