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Holding on


Hi, I have a nearly 4 year old son who is having trouble with toilet training. Until about 2 months ago he had not shown any sign of readiness for toilet training so he has been in nappies. 2 months ago he started wanting to wear undies so we let him wear undies in the weekend and prepared ourselved for accidents however they never came, he just holds on. Sensing that this was bad for him we quickly moved him back to nappies but he still doesn't like to wee in them. His current pattern is that he does wees and poos at 7:30am every morning and that is it, he doesn't wee again all day regardless of whether he is wearing undies or nappies. He is drinking well and has a good diet. He doesn't seem to be in pain from not going wees but during the afternoon he gets more and more withdrawn and agressive because he is uncomfortable. Plunket recommended I try you for advise as I am really stuck and want to help my son.


Answer to "Holding On" Provided by our Childrens Continence Nurse thank you for your e-mail which has been forwarded to me to answer, and my apologies for the delay in replying.

Your situation is a tricky one and it sounds as though there is a great deal of what we call "withholding" happening for your son. Long term this can cause bladder sphincter dysfunction and constipation so you are quite right in wanting to get this sorted sooner rather than later.

I think that three things might be the key here;

1) giving plenty of fluids regularly throughout the day so that he will have to pass urine. 4-6 good-sized drinks of water should help. It would also help to know just how much fluid he is actually having. Sometimes what seems like plenty to us turns out to be very little when we add it all up. Use the Fluid Balance Chart available on the www.continence.org.nz website.

2) start a star chart for just 'sitting' on the toilet regardless of result. Aim to sit him on the toilet 4-6 times a day. Use bribery as appropriate.

3) get a copy of the "Boss of the Bladder" book, available from the www.continence.org.nz website as this has useful information for both you and your child and some amusing pictures. You are then able to explain to him about his bladder and how it needs to be emptied regularly in language and pictures that he understands.

There isnt enough information in your e-mail in relation to whether he uses the potty or toilet, but it would be useful also to look at dad doing some role modeling around passing urine, finding out if he has any toilet fears, what it is in particular that he doesnt like - eg the wet feeling in underpants or nappy?, is he able to get on and off the toilet independently? does he need a stool? does he put off toileting because he is busy? or doesn't want to miss out on play?

Get creative - try putting a ping pong ball in the toilet bowl, give him a low stool to stand on and make a game out of hitting the ping pong ball with his stream of urine. Reward any attempts.

It could also be a good idea to get his urine checked at the doctor's to rule out a urinary tract infection. The doctor can also order an ultrasound scan if s/he thinks it is indicated.

These are just a few suggestions to get you started, please feel free to get back in touch if the problem doesn't improve.