Treatment Options
Treatment of Holding
The treatment of children with holding is very straightforward. As stated above, these problems almost always develop from the child delaying urinating and/or passing bowel movements. Thus, the key to treatment is to initiate regular timed emptying of the bladder and bowels.
Timed Voiding
The first step in treatment is to start a Timed Voiding regimen. This means the child should empty their bladder to completion upon awakening in the morning, and then every two hours during the day, and one final time before going to sleep. An alarm to help remind the child to void every two hours can be very beneficial. An excellent one is available at http://bedwettingstore.com/Watches/item_vibrowatch.htm.
To ensure that the child empties their bladder it is crucial that they take their time voiding (there is no rush). They should take slow deep breaths in and out while voiding and try to relax. Once they are done, have them try to go one more time (Double Voiding), to make sure they get every drop out.
It is important that parents not simply ask their children if they need to urinate every two hours, but actively take them and have them try each time. Be patient! Have them try for several minutes as children are quick to claim that they don't need to go. Positive reinforcement always helps.
| A Voiding Diary is available on the File Download page of this website. |
If your child is unable to make it a full two hours before having to void, they may have not emptied completely their previous attempt, or their bladder may have become "hyperactive" from months to years of excessive holding. You can measure the urine output each time they void to see if they are getting a reasonable amount out as compared to their bladder capacity. See, How Much Should a Bladder Hold? for bladder capacity.
Some physicians may prescribe medicines to help relax the bladder, so it isn't as hyperactive, improving the child's ability to hold their urine. If your child is going very frequently you may want to monitor their fluid intake and try to limit caffeine if possible, as it is a diuretic and a bladder irritant. Orange juice, tomato products, and other bladder irritants should also be avoided. Lists of common bladder irritants are available on many sites online.
Constipation
It is also important to simultaneously treat constipation. Constipation is a big problem in kids with voiding problems, and for the same reason, delayed emptying. Kids tend to hold their bowels, leading to hard, painful stools, which reinforce this behavior. Constipation can also affect how well they can urinate and empty their bladder. Most importantly, most parents are unaware that their children have a problem with constipation. Make sure your child is having a normal, soft bowel movement every day. Are you finding staining of stool in their underwear? This is often a sign of excessive holding.
If you child is severely constipated, a physician should treat them for this. Usually they will perform an initial clean out with laxatives and enemas. Once the child is going, maintenance of soft bowel movements with oral laxatives, stool softeners, and dietary changes should be attempted.
Fiber is essential for constipation treatment, and most kids should probably be on a fiber supplement to maintain soft stools. Benefiber® has worked best for me, as it is a very fine powder that kids can't taste when added to food or beverages. They also sell chewable tablets that kids seem to like. You can find their products at most drug stores and information is available online at www.benefiber.com.
Miralax®, a more potent treatment for constipation in children, has also recently become available over the counter. This is the most effective therapy for children with problematic constipation, and can be used safely for long periods of time.
| Complete instructions for the proper use of Miralax is available on the File Download page of this website. |
It's harder to make a child have a bowel movement than it is to make them urinate, so the key to treating constipation is keeping the stools so soft (with fiber supplements or medications prescribed by their doctor), that is difficult for them to hold and they have to go. Also, every time your child empties their bladder during their timed voiding schedule, it is a good idea to have the child to try to pass a bowel movement if possible so they are at least trying to go very often.