Children’s bladder health – what’s normal and what can go wrong

1. Check out your child’s poo

People often think that wee and poo are totally separate, but although they are completely different systems, the bladder and bowel are so close together that the bowel can really affect the way that the bladder behaves.

A full bowel occupies the space where the bladder wants to expand and fill. That means the bladder is squashed and can’t hold onto very much wee – so your child might do frequent, small wees. The full bowel bumping into the bladder can make it squeeze when it shouldn’t, leading to a feeling of urgency, and potentially day and/or night time wetting.

So when you’re thinking about your child’s bladder, always start by looking at the Poo checker to help you to identify your child’s poo, and note how frequently they are going. A full bowel - constipation - is really common in childhood, so always suspect it – and take action. Children do not grow out of constipation.

Have a look at Advice for children with constipation for more information on how to spot it and what to do about it.

2. Think about the possibility of a Urinary Tract Infection (UTI)

Bugs in the wee can make the bladder misbehave – but they don’t always make the child ill.

So how would you know?

First of all think about whether the bladder behaviour has changed. For example, have they recently started having damp patches in their pants, or wetting the bed? If the bladder misbehaviour has always been the same, it is less likely to be caused by UTI.

Then have a good look at your child’s wee. Get them to wee in the potty if they will still fit on it, or catch some wee in a container placed in the toilet. The wee should not be smelly, or cloudy, or bloodstained. If it is, check out our info on UTIs.

3. Get the drinking right

As well as the right quantity, and spreading the drinks out, we also need to think about what your child is drinking. We all know that water is best, but however hard you try some children just don’t drink enough of it! So what else can you give them?

Milk is fine in moderation – don’t give them milk all the time or they will fill up on it, and eat less proper food and drink fewer water-based drinks.

Fruit juice or squash can be included too, but always very well diluted – think water with a dash of juice or squash. You could also try flavouring water with fresh fruit, either chopped or puréed.

Avoid caffeine – as it is a stimulant, it might make your child’s bladder squeeze when it shouldn’t. If your child enjoys a cup of tea or coffee, help them to choose decaffeinated options.

Some children’s bladders are irritated by artificial colourings, flavourings or sweeteners, or by blackcurrant, orange or fizzy drinks. Rather than banning all these, do some trials with your child –

• Have a week when they only drink water, milk in moderation and well-diluted apple juice, and note how the bladder behaves – for example, how many wetting episodes? How many dashes to the toilet?
• Then add one of the potential irritants, such as orange, and once again note how the bladder behaves over the week. If it made no difference, your child can continue drinking it – and you can trial another potential irritant.

If you’ve offered a variety of drinks and your child’s intake still isn’t enough…

• Think about foods with a high water content like fruit, jelly, soup, salad and yoghurt
• Try and avoid asking your child if they would like a drink, or if they are thirsty. Simply say: “It’s drink time!”
• Make drinks fun with straws and ice cubes – have a look at Tips for better drinking for more ideas
• Use ERIC’s Drinking Reward Chart to plan a drinking timetable with your child. Start with a couple of drinks first thing in the morning to wake up the bladder with some exercise!

4. The importance of relaxing to wee

When it is time to do a wee, messages from the brain tell the two sets of bladder muscles what to do to let the wee out. But unless we relax, the messages can’t get through.

How your child sits on the toilet has a big impact on their ability to relax. Imagine trying to do a wee or poo if your feet don’t touch the floor, there’s a big, oversized seat and your bottom is falling though the big hole, and you’re holding on tight with both hands!

So, what should you do to help them? If your child is small enough to sit on a potty, that’s fine. When they use the toilet, help them to use a children’s toilet seat so they can sit safely and comfortably. A box or stool under their feet should be high enough to raise their knees above the level of their hips, whilst their feet stay flat.

Encourage boys to sit down as well as girls – it is much easier for them to relax sitting down, and it helps the bladder to empty as much wee out as possible. Plus they might not have noticed that they need a poo!

A basket or bag of washable toys makes sitting on the toilet much more fun! Sit with your child and tell stories together. And take your time – if your child is keen to get off the toilet, try sand timers, gradually building up to longer sits.

Think about your child’s sensory needs. For example, is your bathroom a relaxing place to be? Or is it cold, with bright lights and strange smells? Have a look at Sensory needs and toileting

Take time to adapt the bathroom, to create the right environment for your child.

Watch the following video - one of our Family Service advisors talking through advice and tips for making toilet time a more relaxing and enjoyable experience for your child.

This is a 30 minute recording of a webinar recorded in October 2023. Auto-generated captions can be turned on by clicking on the CC icon in the viewing window below.