StepUp Program Frequently Asked Questions
1. What causes children to wet themselves or the bed?
2. Can’t they just try harder to get to the bathroom?
3. Don’t kids outgrow the problem?
4. Why doesn’t my child seem to be bothered by the problem?
5. What should we expect during our visit to the STEPUP Clinic?
6. What types of treatments are used for wetting problems?
Many perfectly normal children experience occasional bedwetting or daytime accidents well into the early school years. In some, however, urine control fails to improve, gets worse, or even first appears well after becoming potty trained. There are numerous reasons that can contribute to problems with bladder control in children. These include:
- Bladders that can not store (hold) the usual amount of urine
- Conditions that cause the bladder to begin to empty suddenly and without the usual warning sensations
- Chronic constipation (very common!)
- Irritation of the bladder from urine infections or other bladder irritants
- Conditions that cause the production of large amounts of urine
- Excessive delay before going to the bathroom
- Sleep disturbances including sleep apnea
- ADHD, emotional problems and stresses,
Since many of these individual factors are interconnected, our patients often require successful treatment of several related problems in order to overcome the wetting or repeated infections.
Children with wetting issues are often thought to just be lazy or too busy to stay dry. This is rarely the case and implies that the child has conscious control over this problem. Some children, especially those with poor daytime bladder control, have underlying problems with the kidneys, urinary system, bowel functions or urinary infections. Symptoms of wetting are easily confused with urine infections or intentional urine holding.
Many kids do outgrow their wetting problems, particularly those who only wet at night and are otherwise healthy. Children should be considered for an evaluation if:
- Bedwetting continues beyond 5 – 6 years of age.
- Day or night wetting returns after months of being essentially dry.
- You observe frequent squirming, wetting without warning, rushing to the bathroom or not making it in time. (Many adults feel that the “squirmers” are so involved in an activity that they won’t break away for a bathroom break. Although this often is the case, be careful not to jump to that conclusion since several bladder control problems have a similar appearance.)
- There is frequent leakage of a small amount of urine into the underwear (“squirts”) on the way to the bathroom. (We know of many children who are so embarrassed that they try to conceal the fact by hiding their underpants.)
- There have been frequent urinary tract infections, especially if these started after toilet training was completed.
Many children will try hard to ignore or deny their wetting problems, appear unconcerned or try to hide the evidence (like wet underpants). Regardless, children are embarrassed about wetting. Poor self-esteem is common and many children are teased in school. Successful treatment improves self-esteem and the confidence to go about routine activities that had previously been avoided, like spending the night at a friend’s house.
Some of what we do during an evaluation depends upon the child’s age, the nature of the problems, and many other factors. You will be asked to complete the Initial Visit Questionnaire (.pdf) and several other forms if these were not previously done. Following this, we will obtain medical and family histories, and conduct a physical examination, which will include a gentle inspection of the external urinary and genital structures. Several non-invasive tests (tests that are painless and do not require penetra tion of the skin or entry into the body) are frequently obtained as part of the evaluation. The most commonly performed studies are:
- Ultrasonography (sonogram) of the bladder and/or kidneys in the StepUp clinic.
- Plain single X-ray view of the abdomen
- Uroflometry with EMG done in the StepUp clinic.
Most evaluations are completed during the first visit. However, in certain situations, it is important to divide the complete evaluation between two visits, with initial treatment beginning between these visits. An average complete evaluation generally takes between 1 ½ and 2 hours.
The treatment recommendations vary, to a large extent based on the type and cause of the problem. The treatment plan also takes into account certain individual and family features (age, size of household, schooling, parent or guardian availability, other medical conditions, etc.). Nonetheless, for more than 90% of the patients evaluated in StepUp, the treatments can be grouped into three basic types: