A Review of Bowel and Bladder Control Development in Children: How Gastrointestinal and Urologic Conditions Relate to Problems in Toilet Training

Abstract

Urologic and gastrointestinal problems in children are of great concern to parents. In most cases, such problems represent no organic disease or serious behavior disorder but nevertheless can cause more serious complications in toilet training than parents recognize. Although bowel and bladder symptoms in otherwise healthy children typically are transient, untreated issues can spiral into physical, behavioral, and developmental problems that disrupt toilet training and maintenance of bowel and/or bladder continence. Chronic wetting and soiling may persist well into the school years and often are refractory to empirical medical treatment. Clinical experience, however, suggests that in most children these problems can be managed successfully within the realm of general pediatric practice. Two important tools for evaluation are available to the pediatrician: good normative data on bowel and bladder function in children, and management algorithms for toilet training that emphasize pathophysiologic patterns within the context of normal development. Interventions emphasize early anticipation, breaking predictable behavioral and dietary cycles that can turn acute problems into chronic problems. This is especially important during the toilet training years. Almost all children have wetting and/or soiling accidents at one time or another. As with other models of developmental milestones, transient regressions or delays in toilet training logically can be expected. Bowel maturation typically precedes bladder maturation, which is not surprising, given the respective complexities of the developmental processes.1 An estimated 15% to 20% of children will become partially toilet trained but continue to have wetting accidents after age 5.2,,3 Additionally, at least 20% of developmentally normal children 18 to 30 months of age may refuse stool toilet training at some point.4 ### Encopresis Children with encopresis (chronic fecal soiling at age 4 and older) typically soil during the day and are unaware of and unable to control their soiling accidents.5 Soiling …