Potty Accidents- Urine leakage- 3 year old
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Where can I turn?! I'm struggling with helping
our three-year-old be successful in using the potty. Our DD began toilet learning in Mid-May. At first, she was
very motivated to use the potty. We went straight to underwear, and she
got stickers frequently throughout the day for keeping her panties
dry. She did very well at the start, but would often have 1 or 2
accidents a day.
And so that pattern has continued. For SEVEN
months. DD's accidents do not include her emptying her bladder; just
"leaking" a bit. Her accidents are more frequent toward the end of the
day -- between naptime & dinnertime is the "danger zone." She can
*very easily* have an accident 20 mins after she uses the toilet.
DD attends school 5 mornings a week, but her
accidents there are much more infrequent; she will only have 1 accident
there about every 10 days. Her track record is much worse at home. 1-2
accidents a day is typical, 3-4 is not unheard of.
She will poop in the potty, but only when she goes
w/ me. (I work 32 hours a week). If I am not available, she will hold
her poop until a sleep period when she has a diaper on.
I have tried to be casual & not pressure her.
I've tried stickers as as a reward for being dry; also prizes she
selected from the dollar store. I do not want to use food as a reward.
I read that using panties is best, so that the child has the feeling of
being wet. However, we do use a pull-up at night (she still sleeps in
her crib) and we use a diaper or pull-up for naptime as well. Both are
usually quite wet after sleep time is over, even though her nap is only
1.5 hours at most.
Since things are worse in the afternoon, I thought
getting rid of the diaper at naptime might help. I tried that last
month. It took her a couple of days, but then she was able to stay dry
during her nap. She got a prize from the dollar store that she picked
when she was successful. However, when we were travelling over
Thanksgiving, she went back to having difficulty. Since she was
completely emptying her bladder AND often having a b.m. during nap --
without a diaper/pull-up, in my sister-in-law's home, I retreated.
I have questioned that there may be something
biologic wrong, but when I discussed this w/ her pediatrician at her
three-month check up, the MD told us that this is a "process" & that
some children take longer. I have avoided talking about "big girls"
using the potty, or "babies using diapers." I try oh so hard to be calm
& nonchalant when there is an accident.
I will confess, however, that I am getting
increasingly frustrated & annoyed. In the past week, I have had two
conversations that have involved much more "shaming" than I've used in
the past. This, of course, has backfired & the accidents seem to
have increased in the last few days. She has been wet at school the
past three days & yesterday she had FOUR accidents total! The
babysitter tells me she peed on her upholstered rocking chair this
afternoon for the first time!!
What can I do? How can I help my daughter be
successful ... and keep from loosing my mind? I'm especially frustrated
because her pediatrician & preschool teachers don't seem concerned,
but her peers seem to have caught on much faster than she. I'm told
that she won't be walking down the aisle in a pull-up, but I'm starting
to wonder if this is true!! Please help!! Thank you!
What a frustrating situation! The first thing to remember is that your
daughter wants to be successful in using the potty. If she is not being
successful, it is not because she is a bad child, or because she
doesn't want to. As you say, in the beginning she was very motivated by
the panties and stickers. She was also successful before Thanksgiving
in keeping her diaper dry during naps, which certainly took great
effort. But something is getting in the way of her being successful at
this big new change in her life. Your job as the mom is to figure out
what's getting in her way, and to help her solve that. As I know you
know, shaming her and getting angry at her will only make it harder for
her to be successful.
I first want to share with you that a small percentage of girls do
suffer from leakage about 15 minutes after they pee, presumably because
they have not fully emptied their bladders. When taught how to properly
pee, this issue clears up. The rest of us for some reason just learn
to pee well enough without these instructions, so maybe there is
something about the kids' bodies that just needs a little extra help.
Here are the instructions used to successfully teach these girls to pee,
that in some cases do clear up the leakage issue:
- Sit steadily on the toilet brim, legs fully supported.
- Keep the legs well apart.
- Lean the trunk forward (as much as you can) making the pelvic tilt forward and the urinary stream more vertical.
- Separate the labia before voiding. At end of voiding, use toilet paper to press and lift the perineum forward/upward (from the base of the vagina and away from the rectum) to empty urine fully.
So definitely do that teaching with your daughter, in case that is all
she needs to clear this up. However, I am betting that it's a bigger
issue. Here are my thoughts.
My first concern in reading
your letter is that your daughter still wakes up soaking after her nap.
One of the readiness indicators that we use to determine whether a
child is ready to toilet train is whether she wakes up dry, as you'll
see on this list of toddler readiness indicators from my website:
Easy Potty Training
Now,
your daughter was able to stay dry during naps for a special "prize"
after a few days of trying. It's not surprising, though, that this new
learning was thrown off in a new environment while you were traveling at
Thanksgiving. You don't say how long she was successful at it, but
the fact that she is presently waking up with soaked diapers makes me
question whether she really is ready to toilet train.
I don't know how many months she is exactly, and I do know that many
kids are exclusively using the toilet by her age. BUT I also know that
there are plenty of normal kids who master this skill towards the age
of four and really, who cares? They all get out of diapers sooner or
later, and our goal is to make it as nontraumatic as possible for them
and for us. The last thing either of you needs is to make your daughter
feel like a failure because you're expecting something of her that she
is simply not ready to do. So there's a big unresolved question --
maybe you started training too early? I know that's hard to hear, and it's even harder to figure out what to do now, since you're been working on this for seven months. We really do want to go forward and make her successful, now that she's trying so hard.
My next--even larger--concern in reading your letter is that your daughter's fairly constant accidents are
NOT about emptying her bladder, but about "leaking." In other words,
she is not running behind the couch while you're out of the room and
peeing on the rug (as many three year olds do, believe it or not). When that happens it is most likely an expression of anxiety or anger.
But
your daughter is not really having full-fledged
accidents, but accidents that consist of urine leaking out in small
amounts. This happens even when she has supposedly emptied her bladder
as short a time as 20 minutes ago. That is a concern to me because it
suggests a physiological issue. Is the bladder somehow not emptying
fully? Is something physically putting pressure on the bladder, so the
urine then finds its way out in small amounts?
I am a psychologist, not a physical doctor. However, I do know that
there are two frequent explanations for urine leakage in children.
First
is if the child is holding in her urine and has a full bladder.
Naturally, small amounts will leak out. But there is nothing in your
letter to suggest that your daughter is doing this. She seems to pee at
home, school and the babysitter. The problem is that even when she
does pee, more pee leaks out in small amounts throughout the afternoon.
(If my assumption about this is wrong, and you think she IS holding in pee, then no wonder she is leaking. IF that is the case, skip the next section and go to the end of this letter where I talk about helping her get through her fears about using the toilet.)
The second common explanation is if the child is holding in her
poop. The full colon puts pressure on the bladder so there's leakage. You
do not say your daughter is constipated, luckily. However, a child who
routinely holds in poop--as it sounds like your daughter does-- can get
blocked up so that even when she does poop, more is left inside her.
The colon gets full. One of the symptoms of that happening is urine
leakage.
This would also explain why when she poops in her diaper at naptime
she also ends up with a wet diaper. It even explains why she would pee
in her sleep even if she does not poop, because if the colon is putting
pressure on the bladder, she would have to exercise a great deal of
control all day long so that she doesn't leak constantly. So when she
sleeps and lets her guard down, the urine comes flooding out. (If this
is the case, think how hard she is trying all day long, to keep the pee
in. But she would need to sit on the toilet constantly to be
successful.)
A pediatric gastroenterologist could take an x-ray of your
daughter's colon and tell you if this is happening. If she is indeed
backed up, the doctor might recommend a clean-out to get her colon
emptied so it is no longer pressuring her bladder. Of course, after that
you would need to make sure she was able to poop every day without
holding. This is important for the health of her colon as well. When
kids hold in their poop, the internal organs can get distended and lose
tone, and the child sometimes stops feeling the signals that they need
to go. So I highly recommend you listen to the clues from your
daughter's body and have an x-ray. If my hypothesis is correct, you will
be so glad to correct this early. If not, then you will be glad to
have ruled it out.
Luckily your daughter is not constipated and is able to go with you
on a regular basis, right? If that is not the case, then I would have
some specific recommendations, and here is the letter on my website that
explains the Soiling Solutions protocol I would recommend:
http://www.ahaparenting.com/
You
can also see from all the comments on that link why I would so strongly
suggest that you rule this issue out before proceeding. It is a big
deal.
If your daughter is pooping every day, then you don't need the
Soiling Solutions protocol but you still might still want to see a
Pediatric GI for an Xray. In other words, I suspect this is a physical
issue and you were right to ask your pediatrician, even though most of
them do not know much about this.
But regardless, I suspect that step one in resolving your
daughter's leakage issue will actually be helping her to poop in the
potty when her body tells her she needs to go, every single day without
waiting. That will eliminate the pressure on the bladder that her
symptoms (leakage) tell us is almost certainly happening. I think the
way to do that is to help her past her fears about pooping. The best
way I know to do that is the Hand-in-Hand method that Patty Wipfler
describes here:
https://www.handinhandparenting.org/2019/07/playful-potty-training-methods/
Of course, your daughter is not resisting either peeing or pooping
in the toilet while you are there, so the Hand in Hand suggestions are
not directly relevant. What IS happening is that she is resisting using
the toilet to poop at school or with her babysitter, right?
So I would
recommend playing school with stuffed animals and then having one refuse
to poop in the toilet and instead ask for a diaper for naptime. But
don't make this heavy. Make it lighthearted and totally silly,
exaggerate the little animal's fears and demands to make your daughter
laugh. Have the little animal almost fall in the toilet, or be afraid
the poop will hurt or whatever makes your daughter laugh. The more she
can discharge her tension about pooping in the toilet at school and with
the babysitter, the more likely she will actually be to do this. Just
keep playing about it; you'll know you're on the right track if she
laughs.
If she doesn't spontaneously begin to poop at school or the
babysitters, you can begin talking with her about doing so, and help her
directly confront her fears about it. You can even have her "pretend"
to do so, by telling her that you want to play school or babysitter and
then put her on the potty at home, pretending you are the teacher or
babysitter, and ask her to poop. Obviously, this will work better if
she actually does have to poop at that moment. If she resists or cries,
follow the suggestions in the Hand in Hand articles. Eventually she
will cry out her fears and successfully poop in your pretend game and
that will transfer to success at school. If she doesn't express fears
in your pretend game that is less good because you don't know if she is
actually working through anything, but keep pretending that the pooping
she is doing at home is happening at school or with the babysitter, and
keep the game going (over time) until she successfully poops.
Eventually she will transfer this success to outside the home pottying.
So, to recap:
1. Teach your daughter to void properly just in case that helps.
2. Stop worrying about your daughter's leakage.
She almost certainly cannot control it because it is a bigger physical issue, probably caused by fecal retention . Address that first. In the meantime, leave her in diapers or pullups at naptime and nighttime and as much as she will let you in the afternoons.
3. Take her to a pediatric GI
for an exray of her colon to see if she is backed up and if so do a clean out. Just tell them that her symptom is urine leakage, and that she won't poop unless you are there but you work so she has gotten used to holding.
4. Help her move past her fears of pooping with anyone but you by using play and pretend.
AFTER
you do all this and your daughter begins listening to her body to poop
in the toilet at school and the babysitter's, I am betting her urine
leakage issue will resolve on its own. IF not, please do let me know and
I will see what I can recommend at that point.
Good luck!
warmly,
Dr. Laura
