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Coping with incontinence.

Toilet training is an important milestone in human development and in Western culture. In our society we attach social value to bladder control. Likewise, shame and embarrassment are often associated with failure to achieve bladder control or loss of bladder control with injury or illness. Gaining bowel and bladder control under even the best circumstances is an amazing feat. There are so many factors that affect the bladder's ability to store and release urine. Let's look at that process.

The kidneys filter waste from the blood. This becomes urine. The urine is moved from the kidneys to the bladder by a gentle squeezing motion called peristalsis. The bladder is a sac-like muscle. As the bladder fills and stretches, it sends a message to the brain via the spinal cord that it is filling and needs to be emptied when it is convenient.

The brain then sends a message back to the bladder that it is or is not the proper time and place to be emptied. When the bladder is emptied, the bladder outlet muscle, called the sphincter muscle, relaxes and opens so the bladder can contract to squeeze urine out. The urine flows from the bladder through a small tube called the urethra to the outside of the body.

Children with mental and physical disabilities may have disturbances in some body systems that control bowel and bladder function. They may not feel the bladder getting full; they may not be able to control the sphincter muscle; they may not be able to understand where or when it is proper to urinate or have a bowel movement.

Urinary incontinence, the medical term for lack of bladder control, is a symptom. It is not a disease. If your child does not achieve urinary continence between the ages of three and five, you should talk to your pediatrician. He or she will probably refer you to a urologist, who will perform tests of the bladder and bladder outlet muscle.

Pediatric urologists have special interest and training in the kidney and bladder problems of children. A pediatric urologist will probably be most helpful in your search for the cause and best treatment for your child's incontinence. The following helpful hints will not interfere with your doctor's treatment and may improve your child's bladder control. At the very least, these suggestions should reduce the family tension that often arises when bladder control is not achieved "on time" or is lost after illness or injury.

Encourage bladder control. Don't punish.

As you have just read, many anatomical (how the body is made), physiological (how the body works), neurological (how nerve messages are delivered in the body) and psychological (how the mind reacts to internal and external messages) factors are involved in achieving bladder control. Daytime bladder control is usually achieved between two and three years of age. Control at night often comes later. If your child has mental or physical limitations, urine control may be delayed for months or even years.

Your child will not understand the inflated value we put on toilet training or the annoyance and nuisance of extra loads of laundry required when bed linens and clothing have been saturated. Separate the physical fact of your child's urine leakage from the psychological and emotional effect the incontinence has on you and your family. Be patient and encouraging. Punishment will not promote continence.

Watch your child's fluid intake.

There are certain beverages children love that may interfere with day and night bladder control. Among the most offensive drinks are caffeinated and carbonated beverages, such as the colas many parents use as special treats.

In addition, coffee, tea and milk may cause problems when it comes to bladder control. Some people have noted that drinks sweetened with artificial sweetener are linked to their children's bladder leakage. Encourage water, pear and apricot nectar and cranberry and cherry juice. Citrus fruits and juices (grapefruit and orange are the most common) should be offered in very small amounts, if at all.

Many children and their concerned parents will limit fluids thinking that less fluid in means less urine leaking out. Actually, your child should be given enough fluids so the urine is colorless and has no odor. Dark, foul-smelling urine is a sign of urine infection or highly concentrated urine. Highly concentrated urine is irritating to the bladder, making the bladder want to get rid of it quickly. Make fluids available in reasonable amounts. Do not use fluids as rewards or punishment to improve bladder control.

Chocolate is also full of caffeine and can be a potent bladder irritant. Try canned or fresh fruits as a substitute to satisfy a craving for something sweet.

Make the toilet safe and comfortable.

The toilet your child uses should have a seat that fits. Many children are frightened when they cannot sit securely on the commode without fear of falling in. This fear may cause their abdominal muscles and bladder outlet muscles to tighten, which can interfere with urination. Feet should rest comfortably on the floor or on a stool. Do not encourage grunting, straining or pushing. Remember, the sphincter muscle must be relaxed for the bladder muscle to squeeze and empty.

You may want to run water, put your child's hand in warm water or pour warm water between the legs to encourage urination. Other techniques people use to encourage the bladder to empty are stroking the inner thights or tapping lightly over the bladder which is located between the belly button and the pubic bone.

Praise is in order when your child passes urine or has a bowel movement on the toilet. Punishment or ugly words are never in order when your child does not "have results."

Protect the skin and self-esteem with the best incontinence products.

There are special cleansers, moisturizers, moisture barrier creams and ointments to keep your child's skin in good condition. As children get older, their urine and stool may become more irritating to the skin. When children are trying to be independent, you can help them care for themselves.

For instance, a squeeze bottle, such as you might put ketchup in, can be used with a rinseless skin wash. Your youngster can squirt the cleanser while sitting on the toilet and blot dry before getting off the toilet. Easy-to-reach continence products and a receptacle to put soiled or used disposable garments will make it easier for your child to tidy up.

Incontinence garments come in many sizes, styles and materials. You have your choice of disposable or reusable. You can combine systems with reusable pants and disposable pads. Many children are eager to have "regular underwear" like their friends have. There are several companies that make these garments.

Help your child find a comfortable, absorbent system that keeps the ego intact and the urine absorbed. Do not use diapers as punishment for daytime incontinence or bedwetting.

Be reasonable about nighttime control.

Children with developmental delays may be very late in achieving nighttime continence. Some may never have complete and predictable control at night. If this is your situation, find a garment or padding system that allows your child to sleep comfortably while protecting the bed linens and mattress.

Learn all you can about how to promote continence at night. Waking Up Dry is a book by psychologist Dr. Martin Scharf. He wet his bed as a child so he know firsthand how upsetting that can be. This book is good for children of all ages and their parents. It will give you everything you need to encourage continence at night if your child's mental and physical condition permits it.

Be an informed and understanding advocate.

Do not let urinary or fecal incontinence limit your child's development or cause family arguments or neighborhood ridicule. Sometimes arms and legs don't work right, words don't come out correctly or eyes don't focus correctly. Sometimes the bladder doesn't work right either; it doesn't fill and empty as we wish it would. This is simply another organ system that can be affected by birth injury, illness or accident. It is not the measure of intelligence or social worth that our society falsely attaches to this system's function or malfunction.
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No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1993 Gale, Cengage Learning. All rights reserved.

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Title Annotation:includes buyers' guide and services
Author:Jeter, Katherine F.
Publication:The Exceptional Parent
Date:Feb 1, 1993
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