Bladder not emptying in 5 year old.

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I'm hoping for advice/ experienced to reassure me whilst we wait to see the consultant!

DS is 5 and has had a history of bowel & bladder issues since potty training. He's been having a minimum of 3 accidents per week since being out of pull-ups, often many more.

In fact, this "high-point", aged around 3/4, we now believe was achieved by not drinking much, which has caused constipation that is dealt with by increased fluids and a daily maintenance dose of movicol.

He is now wetting many times per day; relatively small quantities, so wet pants but not a puddle. It's incredibly frustrating as he can wet himself 20 minutes after I've seen him do a wee. At school he tends to keep quiet about it where he can get away with it so is often sore & smelly.

When he turned 5, a few months ago, he clicked over into NICE guidelines for a referral & we've got a great, though slightly eccentric, consultant who had us do a drink & bladder diary. She noticed that he was doing tiny wees and going to the loo very often & referred for a scan.

We had the scan & I didn't get much from the sonographer, except that he went in with a full bladder (as requested) and she let him go to the loo half-way through. He "emptied his bladder" and when he went back in he still had 100ml of urine. She estimated that he'd had about 140ml before he went to the loo. She also mentioned that at age 5, bladder capacity is only about 180ml maximum, so it's really no surprise he wets all the time.

Anyone had this/ know what causes it? We have a follow up in a few weeks with the consultant but I'm desperate for information.

Anyone?

I have had bladder problems since birth.

Frequent infections caused damage and the infections were caused by me holding too much in my bladder and not feeling the urge to go. Do you have to ask him to go, or does he normally feel it himself? I never had the accidents but could and would go a full day without emptying. I could hold double the "normal" amount in my bladder and it would take some tummy compression to feel the urge to go.

I ended up with one of the muscles in my bladder not fully working and therefore when I go to the loo I don't always completely empty naturally. I did use catheters for a while but I've now trained myself to just sit on the loo a extra 2 minutes and completely relax my muscles. 9/10 times more urine comes out.

When I was a child there wasn't much they could do other than give me a artificial bladder lining to stop the infections taking hold so quickly and encourage me to spend a little longer on the loo.

Side note I also had kidney reflux where when emptying my bladder some urine would back flow into my kidney as I didn't have a valve to prevent it. So I'd go, the urine would back flow and after I'd been to the loo it would flow back down into my bladder.

Another thing, can he stop his pee mid flow? Ie can he control it?

Thanks so much for answering. I'm sorry to hear about your bladder issues.

DS so far, has had no UTIs at all, that we know of.

I'm not sure about whether he can control his pee. It seems like he needs to force it out. As soon as he stops making an effort, he stops the flow. We've done double - voiding (more like quadruple!) to try to help but the constant reminding to go to the loo and then to try again and see if there's any more wee is really causing a strain.

I haven't worked out whether he has a sensation of bladder fullness, as when we ask questions about it, he seems to answer what he thinks we want to hear. We have to remind him to go most of the time.

Sometimes he'll ask to go: when he does it's urgent!

He once told me that he always feels like he needs a wee so he ignores it, but isn't consistent with that.

If he's forcing it could be muscle related - does he ever have any tummy pain?

Must be horrid not yet knowing x

He has tummy pain, but we’ve assumed this was related to his constipation, which we have thought was due to him secretly not drinking enough as a strategy to stop his wetting (his idea, not ours!). I suppose it could be the other way around, and full bowel is compressing urethra or bladder.

Have you had any tests done yet, or do you need to see the consultant first?

You're likely to be offered a voiding cystourethrogram test which isn't pleasant but looks at a multitude of areas of the bladder.

Where's his constipation up to? Being bunged up can cause problems for bladder emptying.

OnNatures The only tests have been the fluid intake/output diary & the ultrasound. Hopefully the consultant will refer for more
I believe we'd have those at our nearish city children's hospital rather than local hospital.

nocool the constipation thing is a bit of a mystery to me. He's never really had days when he's not been doing poos, but seems to only poo, say 80% of what he needs to poo so he gets impacted over a very long period. It was only at peak impaction that he was not going at all. We did a disimpaction regime under the GP advice & he weighed about 2kg less at the end of the week!

He's now on 2 x paediatric Movicol daily as maintenance dose (to be adjusted up or down between 1 & 4 sachets in order for him to be able to produce at least 1 type 4 poo daily). He does good daily poos, but as time has gone on (now 5 months since disimpaction) symptoms of constipation (soiling, reluctance to try to poo) have been getting steadily worse.

We last saw the consultant in early September so he was mainly only having trouble with wetting at that point. It will be interesting to see what her advice is & whether there was evidence of an impacted bowel on the ultrasound.

From what you say, I would wager that he needs a clear out, and it would be interesting to see if that did indeed help the waterworks. It usually does.

Thanks, nocool I really wish we could establish which is the primary issue, it would make life much easier! I keep swinging between, the two. Constipation does seem to be building up, which can’t help. Has anyone heard of gradually cumulative constipation?

Absolutely. They can poo every day, but if they're only pooing out part of what they need to, then the backlog builds up.

www.eric.org.uk/ might be worth a look, if you haven't seen it before?

Yes, ERIC have been brilliant. Told me all of the NICE guidelines to quote to the GP!

Sort- of update: our consultant appointment was supposed to be yesterday but was snowed-off. Medical secretary rang today to say that on the basis of the scans the consultant feels he needs to be seen as soon as possible so we are rescheduled for tomorrow.

Glad there's not a long wait but slightly alarmed by what she might have to say that means she's starting clinic early tomorrow instead of waiting until next week.

Proper update: we’ve seen the doctor.

Scan results showed a distended bladder (50% bigger than normal for his age), though no thickened wall. No kidney damage from reflux , thank goodness!

Secondly, that his entire bowel is full of poo. Palpation suggests no hard lumps so the maintenance Movicol is doing its job at keeping things soft, but he is clearly very backed-up.

So. We have two issues, perhaps related.

Bowel didn’t seem to be impeding the bladder though - apparently if the wetting was secondary to the bowel issues we wouldn’t expect the bladder to be distended.

Initial step is a disimpaction regime to make DS more comfortable. This will be approximately 6 months after the last disimpaction, so suggests it will be a regular thing until we work out what’s going on.

Doc has referred to paed surgery to assess for Bladder Outlet Obstruction as a cause for wetting issues (high pressure, interrupted peeing, high-volume urine-retention & distended bladder).

Doc has also ordered blood tests for various things including RAST test for egg, milk, soya, wheat & coeliac disease. DS also has asthma and eczema & so an allergy might explain the two symptoms plus the bowel issues, I think?

The above actions sort of presume we are dealing with 2 issues, I think, but are easier to rule-out.

Other conditions to rule-out that would explain both issues together are smooth muscle disorders, spinal malformation, nerve issues, but I got the impression that she wasn’t overly taken with those being a great fit (he is a strapping lad, pink and healthy and full of beans).

Anyone want to chip in with anything I’ve misunderstood, or suggest ideas we may have missed?

Sounds like they're being very thorough. It will be interesting to see what happens with bladder function once properly disimpacted...no promises, but sometimes really does make the difference. Paeds surgeons unlikely to want to take things much further without trying that first.

You are now on "operation make the world fall out of their bottom".

Yes, nocool very much looking forward to that!

Chatted to his teacher yesterday afternoon & we agreed to start now & miss the last week of school (Or less if disimpaction goes quickly) rather than wait until the holidays!

I had visions of being chained to the bathroom on Christmas day!

Teacher & I both felt he needs to enjoy the whole of the holidays as he's been very anxious this term as a result of these issues. Disimpaction commences tomorrow (he's in the nativity today!).

DD has similar problems but doesn't retain urine after urinating. Her consultant did advise a second try and urinate immediately after the first to see if there was any urine being retained

She's been on prophylactic antibiotics til she was potty trained fully (til around 6-7years old as we didn't realise she had vowel issues too, so she was often 'overflowing' from her bowel into her pants and causing more infections) and when she's constipated we give her lactulose for a few weeks to help with the bowel

Good luck!

@nocoolnamesleft would you expect to see an immediate improvement in bladder issues after disimpaction if the bowel is affecting it?

flumpybear I'm interested in the different management. No antibiotics here at all. No sign of infection (but he's had 2/3 chest infections per year on average so had them for that).

We were told lactulose is no good (having been given it by the pharmacist before we saw the GP, several years ago) - it relies on the patient having enough fluid in their system and draws it into the bowel, potentially leaving the child dehydrated. Movicol is given as a solution so delivers the fluid as well to the bowel, I understand.

Have you ever done a disimpaction on your daughter? Did that help matters?

We're doing double-voiding (normally we have 3/4 tries and still get more out). Problem is at school we aren't there to remind him.

I'd expect partial improvement after a decent disimpaction (ie at least 3 days of copious quantities of frequent gravy consistency poo - need to see world falling out of his bottom territory).

Lactulose is what we used before movicol was invented. I'd be happy to see the inventor of movicol up for the Nobel prize in medicine, because so many more children actually get better.

Oh, in terms of natural stuff. The evidence is still a bit iffy on probiotics (proper decent dose stuff, not the yoghurts), but some people find it helps.

sorry to hear of the problems you are having! I am dreading potty training as expect my boy to be the same.

My boy was born with ‘bladder outflow obstruction’ which turned out to be something called posterior urethral valves. Unfortunately in our case it was more severe and he did damage a kidney which then had to be removed at 7 months! He’s now had 2 surgeries to relieve the obstruction and is doing much better.

I’m not saying your boy has this, I’m no expert but I imagine there’s other types of bladder outflow obstruction! My boy also has thickened bladder wall and ultrasound shows he retains urine after emptying! He does small and often. We are going to have to delay potty training and are expecting it to be very difficult for him!

If you ever want to discuss what investigations, treatments etc we’ve had then just pm me

Thanks nocool I will bear that in mind. I'm hoping it won't be such a long ordeal this time. Last time it took 10 days to get to the finishing stage. Maybe we stopped too early.

Babydreaming your poor boy . So sorry to hear that he's been so poorly. Thanks for your support. I may call on your experienced opinion further down the line as you were so kind to offer.

She was on antibiotics due to recurrent infections but girls are more prone anyway plus her kidneys are physiologically speaking low down and at a strange orientation so the ureters are at a strange angle too so prone to poooling in her ureters and reflux back into the kidneys

Never had to sort an impacted bowel, we've used movicol periodically but use lactulose as a stool softener when needed, it does work as she usually ends up having the most enormous poop later in the day so we know she's been bunged up a while. Lwsculose is better in think also as it doesn't affect bowel function over longer periods of use where some laxatives do.

Movicol/laxido does not affect bowel function in long periods of usage in children. Not using enough movicol/laxido most definitely does. Lactulose works if you're only mildly constipated. It's pissing in the wind with proper constipation.