Take me out to the ball game: (Potty Training Regressions)

Whitney (the oh, so clever pediatric pelvic health physical therapist) hits it out of the park AGAIN with her final post addressing potty training regressions. This one is filled with advice and problem solving to help you help your kid get back in the game. 

Take me out with the crowd.

It’s the bottom of the ninth, bases loaded, and your kiddo is up to bat! You’ve waited for this moment and you have zero worry on your brain as you sit in the crowded stadium. Why? Because your kid is the MVP. They’ve been at bat 100 times at this point and hit a home run every.single.time. The pitcher winds up, it’s a fast ball coming straight at the plate! Your kid swings and…STRIKE!……….“whaaaa?”

Buy me some peanuts and crackerjacks.  I don’t care if I ever get back!

Yep, it happens to the best of players: bowel and bladder regressions. They’ve been dry, using the potty like a boss, but things have crossed the foul line pretty quickly. And we do care; we want them back.

Potty training regressions can occur for many possible reasons. Some of them are listed below (the most common in my experience as a pediatric pelvic therapist), though usually it’s a combination effect.

• Changes in routine—We talked in previous posts about how creating good routines can help your child to stay dry during the day and night. But, just like for me a weekend of traveling can put me in a digestive slump, a change in your child’s routine can lead to leakage. Are they too busy? Are they holding it too long? Are they constipated?
  • Returning to a normal routine is often an easy way to put on the rally cap, including #2 and 3 below.
• Lack of water intake—Poor water intake causes harder stools and more concentrated urine. We talked a bit in the bedwetting blog about how constipation can cause bedwetting, but it can also cause urinary symptoms or urgency, frequency, or leakage during the day. Concentrated (darker yellow, stronger odor) can cause the same symptoms because the foul urine irritates the lining of the bladder and irritation leads to contraction of the bladder muscle. Contraction=urination.
  • Water intake should be roughly ½ the body weight in ounces, more if the child has a history of constipation or UTIs.
• Constipation—Even though it sounds like an oxymoron, constipation can lead to leakage of poop. When a batter is up to bat and crowds the plate, the strike zone appears smaller, right? Same thing in the body. When the rectum is full (batter), it crowds the bladder (plate) and the volume of urine the bladder can hold is smaller (minimizes strike zone). Plus, the bladder gets quite irritated by its intrusive neighbor and can contract in response (contraction=urination). For a constipated child, the players get sneaky. Solid stool is up to bat in the rectum, and liquid stool awaits in the batter’s box. Suddenly the pitch is released and, without warning, the liquid feces charges the plate and swings. This liquid stool sneaks around the harder stools and exit the anus in a pasty or diarrhea-like fashion.
  • Manage constipation with water intake, a high fiber diet, and a probiotic. The lower end of recommended fiber values are the child’s age +5 until the age of 12 when it reaches 25-35 grams per day. If the child has a history of constipation, more fiber than age-recommended values may be needed. Probiotics can regulate the healthy bacteria in the gut that is disrupted by long-term constipation and taking medications. If your child is on an antibiotic, talk with his/her pediatrician first as some antibiotics can be rendered ineffective when coupled with probiotics.
• Changes in diet—Many foods and beverages can cause irritation of the bowel and bladder. Irritation of these organs lead to contraction of the tissue and (remember?) contraction=urination or the need to have a bowel movement. Some can also block the plate and lead to constipation. Some of these foods are:
  • Dairy (even without an allergy)
  • Caffeine
  • Carbonated beverages
  • Sports drinks (unless excessively sweating)
  • Red and blue dye
  • Artificial sweeteners  (Truvia and Stevia are okay)
  • Excessive sugar / starches (potatoes, bread, etc.)
  • Excessive salt
  • Spicy foods / hot sauce
  • Acidic foods/beverages
  • Now, if you told me I couldn’t have my salty peanuts and sweet crackerjacks ever again, I would think you were out of your dugout! So, moderation is best: limit intake to one item per day from the list and “dilute what you pollute”. If you NEED that 12 oz Dr. Pepper, wash it down with an extra 12 oz of high quality H2O.
• Avoidance Behaviors—Yep, you know it. Sometimes kids avoid using the restroom. They don’t want to stop playing or miss their favorite show. Or maybe the last time they peed or pooped it hurt so bad they fear that it will happen again. Though not the only causes, concentrated urine and UTIs can be a source of painful urination, and constipation a source of painful stooling. If holding patterns go on for too long, kids can lose sensation of bladder or rectal fullness. Then, when the urge hits, it HITS and your kid starts running the bases like his shoes are on fire, but…the pee comes out before he rounds first base.
  • Good water intake and nutritional changes as above can help keep the urine diluted and the stool soft.
  • Time bowel movements for 20-30 minutes after a meal (after breakfast is best). Allow the child to sit for 10-15 minutes and, if no luck, try again after the next meal.
• Peeing too often—Is the child so scared of having leakage that they are going too often? Or are you asking them to go at an inappropriate time “just in case”? The bladder is teachable and if a child pees too often, the bladder begins to think this is a normal pattern. Going “just in case” can cause the bladder to become overactive and lead to urinary frequency (going too often).
  • Normal voiding times for children are about every 2-3 hours for children under 12 and every 3-4 for older children. Try to avoid sending them “just in case”.

Cause it’s root, root, root for the HOME TEAM!

These are the easier fixes, the tweaks of the trade to improve your player’s performance. Often, making these changes can lead to good results within 2-3 weeks. However, sometimes players have an underlying injury that needs a little more rehabilitation and training. The pelvic floor muscles (oh, you’ve heard about those before) can be a contributing factor to ALL of the above problems. These muscles should be the the home-run hitter for the game, the best at bat, the HOME TEAM MVP! But, if not ON their game, they LOSE the game. And these issues aren’t something you as a parent can handle alone.

If they don’t win it’s a shame.

If have one, two, three strikes (you’re out), call your child’s pediatrician and ask for a referral to pelvic physical therapy. This type of therapy is offered to many adults with pelvic floor muscle dysfunction, but not all of these practioners are comfortable working with children. When recruiting for a new coach, make sure they are well-versed in developmental pediatrics as well as the pelvic floor as these two areas combined are what will make for highest batting average for your child. After all, if your kiddo wants to play at the MLB level, wouldn’t you want the best coach for the job? Make your kid the winner at the OLD BALL GAME!!!!!!!

Whitney

About the author:

Whitney Bartley, PT, DPT is a CAPP-Pelvic Certified physcial therapist specializing in the treatment of pelvic floor dysfunction in pediatric patients. She practices in Arkansas, where she lives with her husband and two wonderful children. She’s a fun-loving, Southern gal who is passionate about serving her patients and advocating for children with bowel and bladder dysfunction.