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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For World Bedwetting Day 2021 Bladder & Bowel UK are releasing a series of blogs to help increase understanding of a problem that is not often discussed, but causes stress and distress throughout the world to children, young people, and their families as well as some adults. Here, you can find advice on bedwetting for teenagers and young adults.

Bedwetting in teenagers and young adults

Bedwetting is a very common problem in children, but is less well known about in teenagers and young adults.  However, many in this age group find it not only embarrassing and distressing, but difficult to deal with.

What causes bedwetting in teenagers and young adults?

Bedwetting is caused by a combination of problems:

• Not being able to reduce the amount of urine that the kidneys produce overnight. A special chemical messenger, called vasopressin, usually gets released at night to tell the kidneys to make less urine than they do during the day. That is why most people can stay dry, even if they sleep for eight or more hours a night. If there is not enough vasopressin, then too much urine will be made during sleep.
• Not being able to hold onto all the urine that is made. This may be because the bladder is not big enough, or not working well enough. If the bladder is too small or gets ‘twitchy’ when it fills then it is more likely to empty overnight, even if the kidneys do reduce the amount of urine they make while the person is asleep
• The brain is unable to wake the person up, when the bladder signals that it needs to empty. Not being able to wake up to bladder signals is the main reason for wetting the bed. People who can wake up to go to the toilet will do so. It is the not being able to wake up that causes the wet bed.

Bedwetting is not your fault. it may be helpful to be aware that, not drinking enough during the day, fizzy drinks, drinks with caffeine in, eating salty or high protein foods just before going to sleep, forgetting to empty your bladder before going to sleep and being constipated, may cause bedwetting tor make it worse.

Why haven’t I grown out of bedwetting?

Some children do grow out of bedwetting. However, this is most likely to happen in younger children who are only wet on a few nights a week. Those who wet every night or most nights are least likely to just get better with time.  Although that does sometimes happen, it is not possible to predict who will just get better with no treatment and who will not.

Is there anything I can do to try and help the bedwetting get better?

There are a few things that you can do to help bedwetting improve. Although you may have already tried these with no success, that does not necessarily mean they will not help now.  So, if you are not already doing them, it is always worth trying to see if they do make any difference:

• Make sure you drink well during the day. Having enough water-based drinks will help your bladder to fill properly and stretch to the size that is should be. It will also help to prevent constipation, which can make bedwetting worse. Teenage girls should be drinking about 1 ½ – 2litres of water-based drinks a day and teenage boys should have about 2 – 2 ½litres per day. This should be divided equally into six to eight drinks with the last drink at least an hour before sleep.
• Avoid fizzy and caffeinated drinks, including energy drinks. These can irritate the bladder and cause it to need to become ‘twitchy’. This can make bedwetting worse.
• Avoid eating in the hour before bed. Particularly avoid salty foods and those that are high in protein. Salt and protein encourage the kidneys to make more urine than usual.
• Make sure you go to the toilet just before you settle to sleep.

I have tried all this and am still having wet nights – what else can I do?

If making changes to your lifestyle have not helped, then contact your healthcare professional and ask for an assessment and some treatment. The most common first-line treatments for bedwetting are an alarm or desmopressin. The alarm works by making a loud noise as soon as you start to wet. This is meant to wake you so that you can go to the toilet.  Over a few weeks most people learn to either sleep through the night without needing to wee, or they learn to wake before they are wet.  Desmopressin is a melt or tablet that tells your kidneys to make less urine while you are asleep and is very effective for some people.

About 40 – 60 % of people do not respond to just one treatment for bedwetting. They may need to use both the alarm and the Desmopressin at the same time. Some also need a medication to help their bladder to hold onto urine better. The medicines usually used are from a group called anticholinergics. Your healthcare professional should be able to discuss the most appropriate treatment(s) with you.

I have used these treatments when I was younger – they didn’t work then

Many teenagers and young people who have previously had treatment for bedwetting that did not work , or that did work but where the wetting started again later may feel frustrated, upset, anxious and as if they will always have this problem. However, as we grow up our bodies change. Therefore, treatments that did not work when you were younger may work well later.  Therefore, you should discuss options with your healthcare professional. You can also ask whether there is a local specialist service that you can be referred to.

Where can I find more information about bedwetting in teenagers?

Bladder & Bowel UK is a national charity. It provides information that is free to access, download and print about bladder and bowel conditions and management solutions for people of all ages on their website here. Information on bedwetting is available here.

There is also information on bedwetting on the Stop Bedwetting website. There is information about World Bedwetting Day available here.

Bladder & Bowel UK produce a free quarterly electronic newsletter for the public called Talk About. Talk About is full of interesting articles, suggestions and information for people affected by bladder and bowel conditions. To receive this fill in the form here and ask to be added to the mailing list.

You can contact the Bladder & Bowel UK confidential helpline by filling in the web form or phoning us on 0161 214 4591.

This World Bedwetting Day, Take Action. Contact your healthcare professional if bedwetting is a problem for you or your child.

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There have been lots of press reports in the last few years about increasing numbers of children starting school in nappies.

Sometimes it is thought that families are not trying to toilet train their children. However, this is rarely the case. Most families do all that they can to support their child’s development but may not have any knowledge or experience with toilet training. They may have been advised to wait until their child is ready, without being given any information about what this means. There is some evidence that toilet training later than used to happen in previous generations, may be causing an increase in the number of children who have difficulties with continence (being able to stay clean and dry). Some children may have an underlying problem that makes toilet training more difficult such as constipation, sensory differences or a physical or learning disability.

For primary aged children problems with bladder or bowel control may arise as the result of an underlying condition.

Bedwetting, needing the toilet at short notice (appearing to leave it to the last minute), needing to go more frequently than is typical, or constipation may all impact on school. As bladder and bowel conditions are not talked about very often, there is a lack of understanding that these affect children of all ages. Therefore, teachers may understandably think that the child who is fidgeting because they need the toilet is just not concentrating or has behaviour problems. They may also think that the child who is asking to go to the toilet frequently is trying to escape from classroom routines or difficult work.

For older children and teenagers, management of bladder and/or bowel difficulties in school and college may be especially challenging. There is an expectation that they will use the toilet at break times only, with some schools and colleges even locking toilets at other times. Many young people report feeling isolated. They worry that telling others about their problem may result in bullying, or that teachers will not understand that they have a medical condition. The need to hide the problem and the difficulty of getting to the toilet as and when they need can affect mental health as well as learning.

Over the last few years, the national charities Bladder & Bowel UK and ERIC, the children’s bladder and bowel charity, have had numerous calls to their helplines from worried parents, carers and school staff.

We have also had conversations with school nurses and children’s continence nurses who all told us that there was a lack of understanding of the causes of the problems and a lack of awareness of the role schools can and should play in supporting those affected by these conditions. The schools are very keen to help but need support.

Consequently, Bladder & Bowel UK and ERIC have come together and written a new document to fill the gap. ‘Managing Bladder and Bowel Issues in Nurseries, Schools and Colleges Guidance for School Leaders, Proprietors, Governors, Staff and Practitioners’ was published on 8th October 2019 and is available on the charities websites. It aims to be a comprehensive guide for education settings to help them to understand the numbers of children affected, the causes of the problems and what they can and should be doing to help. It includes the relevant legislation for the four countries of the UK, a sample intimate care policy, a sample care plan and a comprehensive index of continence conditions as well as a directory of sources of help.

To download a copy visit: https://www.bbuk.org.uk/wp-content/uploads/2022/08/Managing-Continence-Problems-in-Schools-2022-paediatic-Bladder-Bowel-UK.pdf

Bladder & Bowel UK also have a confidential helpline for those who have bladder and/or bowel issues, for their families and for the professionals who support them at email bbuk@disabledliving.co.uk or on telephone number 0161 214 4591.

Bladder & Bowel UK have more information about toilet training, day and night time wetting, constipation and other children’s and adults’ bladder and bowel health issues, on their website at www.bbuk.org.uk.

This post was written by Davina Richardson, Children’s Specialist Nurse at Bladder & Bowel UK.

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The theme of International Youth Day 2019, which falls on 12th August each year, is ‘Transforming Education’.

It highlights efforts to make education more inclusive and accessible for young people. It is known that education has many benefits, one of which is better health. In the UK we are fortunate that all young people should have access to education. However, experiences of school and college can be negatively affected by health conditions, including bladder and bowel issues.

It is accepted that nearly a million children and young people in the UK have difficulties with their bladder and/or bowel. While a higher percentage of young children are affected, compared to teenagers and young adults, professionals feel that bladder and bowel problems are often not reported by teenagers. The true numbers affected are likely to be much higher.

There are many reasons why young people do not disclose a bladder or bowel problem.

These include feeling different at a time of life when fitting-in is very important. Embarrassment, shame, anxiety, not believing that anything can be done to help and sometimes previous attempts at treatment that have not worked are all factors as well. Occasionally young people have experienced punishment for having wetting or soiling ‘accidents’ making them feel the best course of action is to hide the problem. A lack of specialist services for young people with bladder and bowel difficulties in some parts of the UK does not help.

Bladder and bowel issues affect young people at school and therefore have an impact on their education. Toilet facilities are not always clean, or well-stocked. They may even feel unsafe for some young people.   Too often young people tell us that they are not allowed to use the toilet when they need to, causing anxiety and difficulty in concentrating on lessons. For those who have open access to the toilet, leaving the classroom during lessons several times a day, disrupts learning and may result in others asking questions the affected person would rather not answer.

Many adults are not aware that continence (bladder and bowel problems) affect young people. Teachers generally want to help support young people, but if they are unaware of the possibility of a problem, let alone that one or more of their students is trying to cope with an issue, they are unable to support.

What causes bladder and bowel problems in young people?

Some young people are born with bladder and/or bowel problems. They may need surgery or treatments in early childhood and may continue to need medical interventions, such as using catheters to drain their bladder, or bowel washouts to help them poo, into adulthood and beyond.

Other young people have not had problems until they were a few weeks, months or years old. Problems which develop when there is no underlying issue with the way the bladder or bowel are constructed are called ‘functional’ problems.  Functional problems include day and nighttime wetting, having to rush to the toilet, having to use the toilet frequently, having constipation or having soiling (poo leaking into the underwear). Functional problems are very common and can affect anyone, although they are more common in those with additional needs. With the right treatment most functional bladder and bowel issues can be cured or improved.

What can be done to help?

For young people who have a bladder and/or bowel issue, the first step is to speak to a trusted adult, visit your GP (family doctor) or speak to your school nurse. They may be able to offer some initial advice and should know who the best person is to speak to in your area.

What about school?

If you feel able to let a teacher at school know about the issues you are having with toileting, they may be able to help. Many secondary schools will provide a ‘medical’ or ‘time out’ card to students who need open access to the toilet. Discuss your needs with them. Disabled toilets or gender-neutral toilets should have bins in them for those who need to dispose of equipment such as catheters or pads.

If your school toilets are not of a good standard or do not provide all the facilities you need, then consider bringing this up with the school council. You could suggest a fund-raising scheme to help improve the toilets, or ask the senior school staff to work with you to get better cleaning and stocking of the toilets.

Where else can I get advice and information?

Bladder & Bowel UK is a national charity that is able to offer resources, advice and information to people of all ages who are affected by bladder and/or bowel issues and to those who support them.

Bladder & Bowel UK have lots of resources and information available on their website at www.bbuk.org.uk that are free to download and print. Bladder & Bowel UK also have a confidential helpline at email bladderandboweluk@disabledliving.co.uk or telephone 0161 214 4591.

This post has been written by Davina Richardson, Children’s Specialist Nurse at Bladder & Bowel UK. To view similar posts please visit www.bbuk.org.uk/blog.

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Many bodily functions are considered private and not for discussion. Top of the list of the ‘not to be talked’ about is toileting! Many people think that once a child has toilet trained their bladders and bowels will work well for the rest of their lives. If they do have problems with wetting or soiling they will only happen when they get really old. This myth is able to continue because so many of us are too embarrassed to discuss problems, even with the people we are closest too. So those young people who do have a problem often don’t ask for help. Read on to discover some possible reasons for toileting troubles in teenagers.

What toileting problems may teenagers have?

Problems that teenagers may have with their bladder and bowels include:

• Frequency – having to go to the toilet for a pee more than seven times a day
• Urgency – having to get to the toilet in a hurry some or all of the time
• Wetting – when pee comes out on its own, usually with little or no warning
• Bedwetting – wetting during sleep. There may be other problems as well, or the bedwetting may just happen at night, with no pee or poo problems during the day.
• Constipation – having a poo less than three times a week; having poos that are painful or difficult to pass; passing poos that are very large, small, passing poos that are very sticky, or hard, or loose; having to strain to poo
• Soiling – when poo leaks into the underwear, either because it gives no warning it needs to come out or because you don’t know it is there

What can I do to make the problems better?

• Drink plenty of water based drinks, spaced evenly throughout the day (about 1 ½ – 2 litres per day for teenage girls and 2 – 2 ½ litres a day for teenage boys, with more if the weather is hot, or you are doing lots of exercise):
  This helps by making sure that pee remains weak (pale in colour) and so less likely to irritate the lining of your bladder, which makes wetting worse. Being well hydrated also helps to prevent constipation, which can cause problems with the bladder as well as the bowel. Drinking well also helps to prevent urinary tract infections (UTI).
• Avoid drinks that contain caffeine (tea, coffee, hot chocolate and energy drinks). These not only make the kidneys produce more wee, but also irritate the bladder and therefore may make wetting worse.
• Avoid drinking in the hour before bed, particularly if you have problems with bedwetting.
• Eat plenty of fruit and vegetables (five to seven portions a day). This helps prevent constipation.
• Go to the toilet as soon as you feel the need.
• Talk to someone about the problems (see below).

Can school help?

If you are having problems with your bladder or bowel, you should be able to get a medical pass to allow you out of lessons, so that you can go to the toilet as soon as you need to. Most schools will provide a pass if they are aware of the problem. You could ask your pastoral leader (e.g. head of house, or head of year) or ask your parent or carer to speak to them. You could ask your school nurse to arrange the pass for you.

If you are worried about the state of your school toilets, or if you have limited access to drinks at school, you and your friends could raise this as an issue with the school council.

What other help is there?

Some teenagers have toileting issues because of a medical condition they have been born with, or that has developed later, due to injury or illness. They may need to use catheters or medicines or to have special bowel management programmes. If this applies to you, then do follow the advice you have been given and if you are worried or struggling let your health care professional know.

Life for teenagers is difficult. There is a natural need to be or feel the same as everyone else. If you had experienced ‘leaks’ when you were younger and were told off for this, because the adults looking after you thought they were being lazy or naughty, then you may be particularly worried about asking for help. You should try not to be concerned about asking for help as there is now a better understanding of the causes of these problems.

At Bladder & Bowel UK we know that having a problem with your bladder and/or bowel (continence problems), causes distress to young people. Feeling the need to hide such problems makes young people feel different and cut off from friends and social groups. Continence problems, if discovered might result in teasing or bullying. They impact on self-esteem. They reduce opportunities of those affected such as avoiding school trips and sleepovers. In extreme cases they can cause symptoms of depression.

Where can I go for more help?

Treating bladder and bowel problems may be straightforward, but for some people takes time and effort for improvement. However, most can be treated. So if you or someone you know is affected do ask for help. School nurses run drop-in clinics in most secondary schools. Your school reception should be able to tell you when the nurse is going to be in school. You do not need to tell them why you want to see the nurse.

You can tell your parent or carer and ask them to make you an appointment to see your GP. If you are over 16 years old you can register with a GP and make an appointment on your own

If you would like to talk about toileting troubles in teenagers, you can contact the Bladder & Bowel UK helpline for free confidential advice by email at bladderandboweluk@disabledliving.co.uk or on the telephone 0161 214 4591.

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