Potty problems

I debated, internally, whether I should write publicly about this. After all, this is the sort of topic that might embarrass a kid. And, as her mom, it has embarrassed me over the years. One of my six-year-olds was still wetting herself multiple times a day, until I sought help.

That shouldn't be embarrassing. My other six-year-old is potty trained, having very rare wet incidents, and so is my three-year-old. I have not failed. If you're reading this and your older kid is regularly changing clothes, you are not a failure.

Potty training is complicated.

After years of struggle and nothing to show for it, not a single week of dry days, I worried. Two of her siblings were trained, and she had reached the age of concern. I'm homeschooling her, but can you imagine what public school would do to her if she was still dealing with this at her age? First, the school itself probably wouldn't accept her. But even if they did, would the other kids? Would she be bullied?

And, although I homeschool, I still expect my kids to be involved in activities with peers, outside of the house. She is taking guitar lessons and a gymnastics class this season. I don't want her to be "the kid who smells". As much as I hate to admit it, there was a, "kid who smells" in my elementary school, and I saw her bullied on a regular basis. She was one of my friends... but I did find it uncomfortable to be too near her.

I took the advice of other parents and put the potty power in her hands. We grown-ups made suggestions about how we thought she should go about it, but left it up to her to decide what was best for her. We tried a timer to remind her to go, and giving the clean up responsibilities to her. But when she was wet ten minutes after her scheduled potty break, almost every time, we assumed it wasn't working and started worrying.

By that point, I had been trying to potty train her for well over four years. When she was about a year and a half old, I got her a potty and put it across from the toilet so she could try it if she was curious. When she was two, I started incentives and regular potty breaks, then a potty chart so daddy could see her achievements when he got home.

I was very positive about the whole situation, and so was one of my six-year-olds, but not the other. She was terrified of the potty.

The first time she did poop in the potty, I discovered that she was definitely constipated. No wonder she didn't want to use the potty. It was hurting her to try. Her sister was getting rewards for pooping, so she was pressured to poop... And it hurt.

At the clinic, her doctor prescribed Miralax. You can get it over the counter. WebMD says Miralax, "is used to treat occasional constipation. It works by holding water in the stool to soften the stool and increases the number of bowel movements. It is known as an osmotic-type laxative." It is intended for adults, but can be taken by children. Ask your doctor first, because giving it to children is "off-label" use, and there is no dosing for children on the label.

That did clear out the problem poop, but didn't convince her that the potty wasn't scary.

I thought it would just take time. It never got better.

After the six-year mark, I finally threw my hands up and decided I had to get help. I was worried something might be physically wrong with her, and I needed to know. We had her on a high fiber diet with fiber supplements, to combat constipation, and kept Miralax around incase of emergency.

I read a book called It's No Accident by Steve J. Hodges, MD, a board-certified pediatric urologist. He also points the finger at poop problems. Even if your child never has a poop accident, there's a good chance that backed-up poop could be causing pee accidents. But my daughter didn't seem to be backed-up. She was pooping every day, and most of them were soft. We tried the Miralax cleanse he suggested, anyway. What could it hurt?

When that didn't improve the situation, I turned to her pediatrician, who referred us to a urology specialist at the Children's Hospital.

There were some preliminary tests my daughter was subjected to, so the urologist could see what she was working with. She had an ultrasound. That came back normal. She had an x-ray. That came back normal. Then, we finally found ourselves in the urologist's office, receiving the good news that my daughter was totally normal, as far as anyone could see.

But, what did that leave us with?

I talked to the urologist about my daughter's potty history. I said what I'm saying, now. She was constipated and scared, early on. Then, something worse happened.

I found myself in an unhealthy relationship with her father, unable to stand up for myself or my convictions, I let him treat her pretty poorly. He over-reacted to her short-comings and terrified her with screaming fits. At one point, when she was about three-years-old, he moved our dining room table into our bedroom to make space for a tiny, plastic-gate play yard, barely big enough for our daughter's mattress, and a potty. He said he was going to leave her there until she stopped having accidents. Her sisters got to roam free and play in the living room, where she could see, but not participate.

That was the last straw. I didn't let that continue long. I finally built up the courage to tell him, "I don't think this is working. I don't think it's going to work" and to take the play yard down. What I was really thinking was much worse. I was crying when he was away, about how horrible this situation had become.

So, the urologist's assistant took us to a special bathroom with a child-sized toilet that had a machine built into it to measure how much my daughter peed and at what rate. Directly after my daughter used that toilet, the assistant used a tool that seemed similar to an ultrasound wand and measured how much urine was left in her bladder. Reviewing the results with the urologist reveled that my daughter was only half-emptying her bladder at any given bathroom break.

Put simply, this is what was happening:

When you void, your bladder contracts to push its contents out. When you're not trying to pee, your urethra has muscles that tighten around it to hold urine in, even when you don't feel like you have to go. Your urethra is basically holding a cap on your bladder while it fills up, slowly, over the course of hours.

When you sit down on the toilet (if you're a man, replace with your own bathroom scenario), the muscles closing your urethra need to relax while your bladder is emptying.

Potty terror, and then accident terror, had trained my daughter's muscles to fight each other. On the toilet, her bladder would be trying to empty, but the muscles around her urethra would never relax enough. Her bladder was saying, "let's go" and her urethra was saying, "no." So, she was always carrying at least some urine.

What's the solution? Retraining her body. It's actually not that difficult, but the specialist said it will take time (at least 3 months).

We have a schedule. She goes potty every two hours, throughout the day. She needs to go regularly and often to keep her bladder from ever being over-full. That way, the muscles around her urethra can start to relax, without so much pressure pushing down on them.

Every time she goes, she tries twice. She completes one whole bathroom trip, all the way up to putting her pants back on, then she goes back and tries again. This is called double voiding, and it helps by repeatedly triggering the response her body should automatically have when she prepares to void... relaxation. Of course, it also helps give her an opportunity to get more than half of the urine out.

I've also created a chart for her on which I can record her bathroom activity and accidents. It is important for me to keep track of her stools because constipation has been an issue in the past, and can be again. The charts have been a great reminder of her progress, as well.

We check back in with the specialist, for another round with the special toilet, after three months of this routine. I'm optimistic. We're maybe six weeks in and she's only having a few wet accidents per week, and we've basically eliminated bed-wetting.