Toilet issues with a 10 yr old DD (long)

[Momoftwogirls]

DD1 (10) had some bladder issues when she was younger. Frequent UTI, diagnosed with VUR. Has some slight scaring on one kidney. But VUR seemed to resolve itself as she got older.

So good toilet hygiene is VERY important .

But: If she is busy with an activity or with friends, she will hold off going to toilet until very last second. In fact, it it not unlikely that she will hold off going to toilet until too late, and she actually wets herself. It happened just last week when she had a friend to visit. It happened 2 months ago when she was visiting a friend. I reckon she has such an accident at least 4 times per year, maybe more.

I/DH regularly need to remind her to go to the toilet, when we see her 'hopping'. She will often resist, saying she doesn't need to go. I must admit, once she resists, and we know she needs to go, it is often resolved by shouting at her. (She is so stubborn, reminding, asking nicely doesn't seem to register with her at all. We do ask nicely at first, then more stern, and finally shout an order that she must go, NOW. Not great, I know.)

This isn't limited to when she needs to wee. Several times a month she will have serious skid marks on her panties. So Poos are an issue too. She does understand that in these cases she needs to change her panties as soon as possible, as this is likely to lead to a UTI. Mostly, she will do this.

We regularly speak to her about the importance of going to the toilet as soon as she feels the need. And making she sure she wipes her bum properly. Her pediatrician and GP has had same conversation with her, many times. I know she hears and understands this message. Generally, she is a bright kid.

I can't figure out if she is not correctly receiving the signal that she needs to go to the toilet when she is otherwise engaged in an interesting activity, or if she is ignoring this signal on purpose. My feeling is that she is ignoring it, but part of me wonders if she really is not totally aware.

Sometimes, I do wonder if she has a processing delay. She does seem to react a few seconds later than her younger sister does. If you ask her something, she seems to need time to digest it before responding. (Unless it is a smart remark, then she is super quick off the mark.) But I'm not sure how much of that is just an issue with focusing.

Another thing we struggle with is ensuring she drinks sufficient liquids during the day. She doesn't really like water, would prefer orange juice. Generally I give her 3 parts water to 1 part juice. 1-2 drinks may be 100% juice. The days when she doesn't consume enough fluids, her pee smells really strong. i.e. I can still smell the strong smell if I go into bathroom immediately after she flushes toilet.

Any with similar experience? Any advise of what I can do to help her?
I am concerned for her as she get older, that her friends/class mates will cop onto this, and this will become a social issue for her.

Sorry its so long. Thanks for reading.

[BellaTalbert]

Hi my 10 year old dd has very similar problems. I was told by a specialist to get her to clean her underwear herself which has had some results as well as to buy her the undies that she wants and when she has has 5 clean days she gets to pick a pair. My dd still wets the bed pretty much every night she is on two different types of meds but 3 years down the line looks as though she will need surgery. My dd is a nightmare when it come to drinking, I have to nag her all the time otherwise she won't drink. Whilst on holiday she wet herself as too in grossed in what she was doing. DD has been told repeatedly the reasons why she needs to drink plenty and that she will be able to go to and have more sleepovers as she would wet the bed less (pull ups always leak). We have to go back to the consultant in a few months to see if surgery is the right route.

[peeriebear]

Same problems here with 10yo DD! We are in talks with her school nurse now and finally making some headway- basically the problem is that DD needs to retrain her bladder as it is working very inefficiently. To do this she needs to go to the toilet regularly even if she doesn't feel the need, and drink regularly even if she doesn't feel thirsty. DD is stubborn and awkward and after initial headway, we were back to to square one. The school nurse had to basically get a bit stern with her and tell it like it is- that she wasn't trying and that she had to do her part instead of expecting the problem to magically resolve itself with no effort from her. Now she is drinking more without being constantly nagged, and going to the toilet more though I do still have to remind her. I really hope we get to the end of it because it's so bloody wearing!

[Momoftwogirls]

Thanks for your replies. It is somewhat of a relief to know she is not the only 10 yr old with this problem.

Bella - The tip about cleaning her underwear is helpful. I think I will introduce this. Good luck with your return trip to consultant.

A question to both of you. My DD generally doesn't seem too bothered about this problem. She will lie her way out of situations where she actually wets herself (if she wets so much that she soaks thru). But other than that, I generally get the 'yeah, yeah, whatever' attitude from her. She doesn't show an embarrassed face to me at all. Is this similar for your DC?

[BellaTalbert]

my dd sometimes has that attitude but since I make it her responsibility to clean up she is not as bad. dd has to strip and remake her bed, put it in the washing machine etc (advised by school nurse not as punishment but taking responsibility). I do have to remind her that people will pick up on the smell and their reactions to this, she does seem to becoming around. Thanks for the luck xxx

[peeriebear]

Yes it is similar Momof! One of the main problems with DD1 is that she will NOT tell me if she's had an accident in her clothes- I have to smell it on her by which time it's dried and she smells foul, because of the concentrated urine She gets VERY defensive and prickly and downright rude when asked if she's had an accident, will try to lie about it (even though it's obvious), tries to get out of having a wash!, will hide smelly washing inside the pile. I have explained till I'm blue in the face that I NEED TO KNOW so I can monitor how well she's doing because I have to liaise with the school nurse, and that if I can smell her then her friends can.

[mathanxiety]

In the case of a neighbour, their doctor advised throwing out underwear and clothing their DD peed in and soiled. They tried making her wash her underwear but it was almost as much work as doing it themselves and the DD would hide peed-in undies and jeans. The DD ended up with virtually no clothes. I don't know how it all ended up as we moved and lost contact.

I myself wondered if it was a form of ocd but I didn't butt in. There is a form of ocd that involves 'hoarding' of body waste but it has to come out since it can't be retained forever. There is a lot of tension associated with this. There can also be ocd type fears of contact with a contaminated item (the loo).

If she has had a few cases of strep throat or another sort of strep infection you could look into PANDAS symptoms.

Cut back a lot on the OJ or better still stop giving it to her altogether. Too much vitamin C can cause loose stools. The UTIs could also be related, in a vicious circle. There is a high level of acid in OJ and it can irritate the urinary tract. Are you absolutely sure she has had UTIs and not interstitial cystitis? She can get a wide range of vitamins from fruits and veg like peppers and need not rely on juice.

VUR can cause burning or pain while urinating, and also foul smelling urine. Perhaps too much acid in her urine could also be causing her problems? Maybe she has felt pain on urination and is now reluctant to feel it again? Maybe she won't poo either as she would need to poo if she peed?

[Momoftwogirls]

Hi Mathanxiety,
I'm working on the OJ. I'm filling her cup/drink bottle with 75% water, then adding the OJ. And during the hot weather, water was her drink of choice. I'm going to try wean her from OJ and get her mostly drinking water. I'm planning to cut down the ratio of OJ to water in the coming weeks, now that she is back at school. I need to balance this switch with ensuring she consumes sufficient liquids. If I go to 100% water too soon, she just won't drink.

Thankfully, she has never had strep throat. When she had the UTIs, her urine samples have been sent to the lab. I presume this would have identified interstitial cystitis? Do you know if it would?

She isn't a hoarder, in the true sense. While she does hide wet/soiled underwear/jeans, it is always within the laundry basket, and it is because she knows I'll be annoyed if I find it. (She seems to think if it dries before I find it, I won't know...)

Normally, she doesn't have a problem with soiling, it is more to do with correctly wiping her bum. But maybe this is related to loose stools, caused by too much vitamin C? But certainly about once every one to two months, it does look like she left it too long before going for a poo. This normally coincides with having something 'really interesting' going on. i.e. playdate at home, etc. Those panties do get put into the bin. (I will wash out skid marks, but nothing more)

I am nervous about making too much of a fuss about throwing out/making her wash soiled panties, etc, as I am afraid it will make her be more secretive. At least now, I know all the dirty clothes make their way into the laundry basket.
Also, I am pretty sure the problem with 'holding on' is to do with 'not wanting to miss anything' rather than physical. I have questioned her about this many times.

One thing of concern to me, is that I'm not sure she always recognizes the signs that she needs to go to the toilet, as opposed to ignores those signs, when she is absorbed by an activity.

Finally, she is dyslexic, and often has a process delay when she needs to react in any way. (i.e. Ask her to get dressed, brush her hair, ask her times tables, to move 'out of the way NOW', etc. All of these involve a considerable pause before she takes action.)
I often wonder if there is any relationship between this, or if it is just coincidence.

The good news is that other than two or three minor skid marks, no accident since I first posted on 19-Aug.

[sashh]

Maybe have an alarm with a set time. When the alarm goes she goes. And if she doesn't feel like it then she has to go to the toilet, pull doen her pants and try.

Once she gets into a set pattern she will recognise the urge.

But I have a 50+ friend who will delay for an hour or so when she is doing somethign interesting.

[HappyAsASandboy]

I don't really know what to advise, but I wanted to share what it's Luke from your DDs side.

I used to regularly wet myself (more often than you've described) until about age 10 or 11. I also wet the bed until about the same age. I honestly don't think I was ignoring the signals - as you said, I was just too engrossed in what I was doing, and so forgot I needed to go. Then it's too late. I was embarrassed and used to lie to my mum (I was forever falling over in puddles on sunny days!) and 'hide' my wet clothes in the laundry basket. I probably certainly came across as defensive and arrogant about it to my mum, but that was definately a front for the embarrassment.

I grew out if it mostly. I wasn't doing it when I changed schools at 13, and the bed wetting certainly stopped before then.

Please don't try to discipline this out of your DD If she's anything like I was, she's really not lazy or naughty, she just gets distracted easily and forgets she needs the loo. When her parents bug her asking if she needs to go she finds it embarrassing that they know she needs to go and denies it and the whole thing turns into an embarrassing struggle .

If I were in your position, I''d ask her to put any wet clothes in the washer herself. Then you could look in the washer before bed each night and deal with the clothes if there are any. That way the soiled clothes aren't hanging around smelly, but only you (not her father or siblings) will know what's happening. You could let her know that you're happy to take her to the doctors if she's worried about it, and then give it some time.

[DewDr0p]

I had v similar issues with my Ds albeit at a slightly younger age - we were advised to avoid OJ as it can irritate the bladder.

What helped massively was sitting down together and drawing up a contract - his side was about drinking x amount and going to the toilet x times per day. Mine was about reminders and not getting cross. We started in school hols and got school on board too.

I would really recommend the ERIC website, their advice is fantastic - we also had great support from our school nurse, she was brilliant.

It was a long slow hard process and I remember feeling like we were never going to get there but we did and it's ancient history now so hang on in there - this can be resolved!

[OrangeLily]

oh this is such a hard situation.

From personal experience it may be she just hates going to the loo. This may not be helped by things like school toilets. Some really good advice from people here so don't want to just repeat it. I still hate going too and will delay a bit but know as an adult you have limited time a lot of the day when you can go!

[Cobon]

This is incredibly helpful. I've had similar probs with my 9 year old - mainly bedwetting. She drinks OJ too although not as much as she used to. I might cut it out altogether for a while and see what happens. I also think the amount she drinks has an effect (she prob doesn't drink enough at school). I remember having some similar problems when small too so haven't taken much action yet but I do make her strip the bed. My main issue is that as a working Mum I just cannot cope with the amount of laundry generated especially in the winter so occasionally I go a bit balistic. It's also been a problem on holiday and sleepovers. A friend who is a GP said that it's unlikely that medical intervention is necessary but an alarm might help. Thanks very much everyone and good luck.

[basildonbond]

it sounds like she's constipated to me especially as she's not drinking enough ... ds2 has had chronic constipation for years so we're all too familiar with it

poo 'seepage' happens when liquid matter from further up the digestive tract ends up bypassing more solid stuff stuck in the colon - the colon gets distended and the signals which she should be getting to tell her she needs to get to the loo get weaker - it also means wetting is more likely as the distended colon puts pressure on the bladder

the 'blase' attitude is probably because she's actually hideously embarrassed but if she pretends it hasn't happened then it hasn't! (iyswim)

we have a fantastic paediatric continence clinic at our local hospital headed by a nurse specialist who ds2 knows as the 'poo lady' - she's brilliant and has saved my sanity ...

If you can get a referral to your local equivalent - if it's a physical problem, then no amount of shaming her or getting her to wash her own knickers etc etc will help

[P51mama]

I really sympathise with you on this. I have the same problems with my 9 year old daughter, although she doesn't often actually wet herself. She holds until she is absolutely desperate and can't walk and, as with your child, denies needing to go, and refuses to go, even when it is obvious. Pooing is the biggest problem we have. She will go for a wee and then 2mins later be racing back to the toilet for a poo but it's too late. She also doesn't seem to be bothered or have any shame about sitting about in very dirty pants all day, she will even sleep in them if I don't force her out of them at bedtime. We had a serious incident with it last night, she had sat through dinner and played with heavily soiled pants and then tried to hide it all when getting ready for bed. I snapped and made her clean it all up and wash her underwear out etc. I couldn't help but tell her how disgusting it all was. It is one thing having an accident but to ignore it and sit about in it for hours is beyond my comprehension.

I just don't know what to do anymore about it. I feel terrible for punishing her if she can't help it but also can't let her think it is ok. I must admit all the other characteristics of your child ring true also and we have been seriously considering having her tested for ADHD as we have a lot of behaviour issues. DD has a low sugar diet anyway due to her 'busy' nature so is only allowed 1 or 2 heavily watered down juices a day, otherwise it is water. We also eat a very healthy, natural as possible diet so I don't think too much processed food is a problem.

If nothing else it is reassuring to hear other parents having similar issues. Thanks for sharing.. I thought I was alone on this. Good luck.

[blameitonthecaffeine]

P51mama - have you had your daughter assessed by a doctor? My 9 year old has similar problems and it turned out to be related to OCD. She is terrified of using toilets that she is unfamiliar with and, as you describe, will hold on until she can't walk and will sometimes have very embarrassing accidents. She never wets at home and school have been great at making her feel comfortable with a particular school toilet so she is now fine there. But elsewhere it can be a nightmare. She doesn't have a problem with pooing as her issues are limited to unfamiliar toilets but it might be worth checking with your dd and her doctor that she isn't harbouring any anxieties.

[ClareMarriott]

Years ago when one of my sisters was younger and absorbed with playing in the garden with friends, our mother would keep a pair of knickers warming on the stove and when she thought my sister looked as if she needed " help " would go outside and say she just wanted to see my sister for a minute, then once inside anything could be sorted out. Worked a treat .

[P51mama]

Thanks blameitonthecaffeine... OCD wouldn't be a great surprise in our family!