what indicates a medical cause for a child who won't potty train?

[K-Mom3]

Who can tell me about incontinence? How do doctors test for it and how can I tell if DD needs the test?

My daughter can't quite seem to get it, no matter how hard she tries. She'll get better for a few weeks while we're working on it but she still always has one or two accidents per day. It seems like she's leaking, even when she's trying really hard. She is 3.5 and started potty training about 2 years ago. She never goes longer than 1 day without an accident and so after a few weeks she gives up and wets her in her pants all day long.

I'm reluctant to bring it up to her doctor because I think that they'll keep telling me to wait, wait, wait, when she's READY she'll get it. I'm not so sure....

[ASusan]

Is there any chance she has a food allergy/intolerance? Check into the allergies forum. Many mamas there say that a backslide/accident/misses in toileting are signs of an exposure to a food that a child is allergic/intolerant to.

[luv-my-boys]

a developmental pediatrician would be able to help you to see if its "developmental" as in she's not ready or if its physcial.

[GoBecGo]

I think it would depend on the degree and type of incontinence. I have a friend whose LO has spina bifida occulta, and can walk and everything but is incontinent. THat LO has no control, they void both poo and pee whenever they are "full" and though they have some awareness of bowel movements being imminent, they don't have any awareness of their bladder. That child is 6 now. I think the plan is some sort of surgery and then the child will be taught to cath themself to give them that control. Not sure though, at the moment they wear discrete pull ups.

OTOH i am pregnant and have stress incontinence and NOTHING is predictable about it! If my bladder is full i don't even leak, if it's almost empty i might void whatever is in there. Sometimes i cough and it happens, other times i sneeze 3 times in a row and...nothing.

I would see a doc if you're worried.

[JudiAU]

It could be anatomical. One of nieces had a similar problem that remains well until elementary school. My sister finally came to accept that she simply did not have a lot of sensitivity to bladder feelings, perhaps as a result of some minor surgery and/or some prolonged antiobiotic use she had when much younger. Of her four children, she took two or three times as long to train but is still, at seven, subject to occasional accidents. She would often go nine or more hours without going and then have a problem and really felt no urge.

My sister's approach has to been to have a series of private conversations with her so that she understands that 1) when mom suggests that everyone goes to the bathroom she is always to go to the bathroom and thus mom doesn't have to single her out all the time and embarass her, 2) that she understands that she can't always rely on her body's signals, 3) that while ishe s in school she will go to the bathroom at two specific time each day whether she feels the need or not. This has allowed her to wear regular underpants and avoid any accidents at school.

This approach has worked pretty well for an older child but you might want to encourage some regular pottying if you don't. She did take her to a follow up visit to the urologist list year before she started school and was told that subtle conditions aren't always physically detectable.

At 3.5 it could either be physical or developmental.

[Monkey Keeper]

Is she constipated at all? My niece dealt with constipation for quite some time, as did my DD while potty learning. For my niece, a full colon resulted in a feeling of urgency to urinate even when her bladder was not full--this occured during kindergarten or so, so not related at all to potty learning. It's possible that a situation like that may have short-circuited your DD's ability to feel urinary urges appropriately. For my DD, OTOH, she leaked urine and had accidents because she was packed so full of feces (gross, I know) that she physically could not hold her urine.

Other than that, I was going to mention mild spina bifida as one of the other posters did. They checked my DD for that when dealing with constipation/stool refusal to be sure that it wasn't an issue with her not being able to void stool.

[K-Mom3]

I took dd to her pediatrician today. He listened to my story and said that yes, by her age she should be able to be able to stay dry during the day, at least. He said that the most common cause is constipation. Like, if her bowel is full all the time, maybe it doesn't feel different when she does or doesn't need to pee. BTW, dd does seem to poop regularly but the ped said that sometimes kids just don't poop it all out and there is still a possibility that she is constipated.

So, we're going to do an x-ray to see if her bowel is full. If that test shows nothing, he'll move along to the next thing on the list.