Saturday 2 January 2016

Bladder Control - Why Children Deny They Need to Pee.

Many parents tell me that their child denies that they need to pee even though the child is clearly posturing in a manner that indicates that they do need to pee. 

This can lead to a confrontation between the child and the parent. Many parents share that they are frustrated and that they get upset with these events. Confrontations and getting upset are never a good idea.

These children have a problem with daytime wetting and the parent would like to help the child to stay dry. The parent would like to be patient, does not want to precipitate a confrontation, and does not like getting upset. However, when the situation happens over and over again, many parents lose their composure over this issue. 

The usual story is that a child is engaged in a compelling play activity. The parent observes typical holding postures. There are many variations of the "pee pee dance." Mostly the children fidget, squirm, squeeze their thighs together, hold their groin area with a hand, tap their toes, or shuffle their feet. The parent knows that the child will either wet their clothes while playing or, that finally the child will disengage and run but wet on the way to the bathroom. 

As soon as a child starts to hold the pee on a regular basis they start to lose touch with the early signals of bladder fullness. Once a child is posturing and starts to deny they need to pee, they are not lying, they have actually lost touch with the early signals. 

Some parents have trouble accepting this concept. They believe that because the child is posturing and because this happens so often and usually ends up with wet clothes, and because the parent has pointed this out so many times, that the child must know what is going on. They tell me their child is "lazy" or that the child is "stubborn" or that this is a "control" issue. No, No, and No. These children have lost touch with the early signals and actually do not not know they need to pee. 

The early bladder-pressure-signals fade away in a fashion similar to how "background noise" disappears. The noise is there but we no longer "hear" the sound. We have five senses and the brain can "accommodate" our perception to any of these senses and make the sensation go away. 

Another way to conceptualise this situation is that the inability of the child to realise they need to pee might be an inability to "multitask." The child is usually engaged in a compelling play activity that has used up all the "attentiveness" available for the child. The bladder signals cannot compete with the compelling play activity signals. 

Some children have learning problems and testing reveals that they have difficulties "processing" information. This is a common observation in children with Attention Deficit Hyperactivity Disorder (ADHD) or Attention Deficit Disorder (ADD). Having a processing problem is similar to an inability to multitask. 

Some parents worry that there might be a nerve problem in their child. The nerves in these children are normal. The presence of the behaviour confirms that the brain-bladder nerve communication is intact. The holding postures are a consequence of an intact full bladder to brain communication. The nerves are OK but the child is not in touch with the signals. 

I explain this carefully to parents to help them understand the problem and in the hope that the explanation might help the parents to be more patient and to avoid confrontations with their child. 

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