Many older children experience potty training problems. The most commonly reported issue is bed-wetting, medically known as enuresis. In the early elementary years children can also experience daytime wetting accidents, known as diurnal enuresis. Constipation and encopresis, leakage of feces into the underwear, can also be concerns.
Bedwetting--Enuresis
Many children struggle with bedwetting although it is considered normal in the developmental process until the age of six. Boys tend to experience bedwetting more frequently than girls. Bedwetting often runs in families with older siblings or parents who have a history of it. Children who are deep sleepers or have trouble waking from sleep may be affected as well. Medical issues such as hormones, infections and malformations in the urinary tract or bladder can also be contributing factors. It is important for caregivers to understand that bedwetting should not be punished and that it is not a behavioral issue or indication that the child is lazy.
Daytime Wetting--Diurnal Enuresis
Children who wet themselves during the day are experiencing diurnal enuresis. This diagnosis is given when wetting occurs after a child has been fully potty trained. While daytime wetting is not as common as bedwetting, many children who experience it also struggle with bedwetting. Stress and changes in a child's schedule or family life can contribute to the problem. Additionally, children who hold their urine for extended periods of time and urinate less than three times a day are often affected. When they do urinate, affected children often do not completely empty their bladders leading to further wetting accidents.
Constipation
Constipation is diagnosed when a child has large hard or dry stools that are difficult to pass and the child has less than three bowel movements a week. Children can suffer constipation when they do not get enough liquids or fiber in their diet. Constipation can also occur when children hold their bowels frequently, resisting the urge to go, due to not wanting to interrupt play or being embarrassed about going in a public restroom. Certain medications can also lead to constipation.
Stool Soiling--Encopresis
Encopresis is when a child soils his underwear with feces. This is most commonly a small amount of feces, but can be a full bowel movement. This type of soiling is an involuntary act and is usually quite embarrassing for the child. Encopresis can occur due to constipation, fear of using the toilet or irritable bowel syndrome.
Medical Support
There are often underlying medical issues contributing to potty training problems in older children. A pediatrician should be consulted for toileting concerns that occur on a frequent basis. Behavioral modifications, medications, and on rare occasions, surgery, are options that may be utilized to assist a child in recovering from these toileting problems.
