We asked children's continence nurse and National Continence Helpline consultant Janine Armocida what parents and children can expect in a continence assessment.
Q: When should a child have a continence assessment?
A: If a child is having regular daytime wetting or soiling accidents at the age of four, or has been successfully toilet trained but starts soiling or wetting at a later stage, they should have a continence assessment.
If a child is still wetting the bed regularly at the age of six or seven, they should also have a continence assessment. We know 20 per cent of five-year-olds and 10 per cent of seven-yearolds still wet the bed and the sooner the child has treatment the better the outcomes. It is a myth to believe that all children will grow out of bedwetting. Anyone – parents, GPs or specialists such as paediatricians – can make a referral.
Q: What do you look for?
A: We check for neurological conditions such as spina bifida occult by observing the child’s gait, checking their muscle tone and lower limb strength, and their spine, particularly the lower spine.
We also check for urinary tract infections with a simple stick test. We look at the colour of the urine; if it’s dark the child may not be drinking enough, which can make their urine too acidic and the bladder more unstable. We also palpate the child’s abdomen to check for constipation.
Q: What is a bladder and bowel diary?
A: A bladder and bowel diary provides important information about the possible cause of the incontinence and the best way to treat the problem. We ask parents to record their child’s fluid intake, each occasion the child empties their bladder (and the volumes) for three days, and their bowels for one to two weeks using the Bristol stool chart. It’s also important to record any accidents and if the child initiated toileting or needed prompting.
Download the children's bowel diary
Q: Describe a uroflow test?
A: We use a flow toilet, which provides a printout of the urine flow rate as the child empties their bladder. It should be like a bell curve – starting off slowly, strongest in the middle and tapering off at the end. This helps identify any voiding dysfunction.
Q: What is a bladder scan?
A: It’s an ultrasound that checks whether or not the bladder is emptying fully. If a child doesn’t empty their bladder fully it puts them at risk of developing urinary tract infections or other problems.
Q: What tips do you give them about going?
A: It is important to teach children to relax on the toilet for both bowels and bladder. We teach them how to sit properly – with their back straight, bending from the hips with their hands or elbows on their knees. If a child has a wetting problem we might ask them to count to 10 once they have finished to encourage the bladder to empty properly.
To encourage children to empty their bowels properly we encourage them to sit on the toilet for five minutes, about 30 minutes after a meal, to take advantage of the gastro-colonic reflex, which is a mass movement of contents through the bowel.
When toilet training boys it’s a good idea to get them to sit. They will be able to stand when they’re older, and it’s much easier to ignore the call to do a poo if they’re standing up, which could lead to constipation.