Parents often have concerns that their child is going frequently to the toilet or wetting themselves during the day. A paediatrician reflects on why this may happen in some children.
An article on Medscape earlier this year caught my attention “Froot Loops and Kegels and Beer (Oh My!)”. Here a paediatrician presents a case study of a child that is brought in by his mother. She is worried as to why her son is urinating every half an hour. Here is an abridged version of the article.
“The urine had the colour of a warm Bud Light. Good news, I thought, as I knocked on the door and entered the room.
Inside sat a five-year-old boy and his mother. The boy looked fine and healthy and was engaged in paging through a book. Mom, on the other hand, looked nervous.
Before I even stretched out my hand in greeting, I said to the pair, “No infection, no diabetes, and no stones.”
A nearly audible sigh of relief came from mom. “So why is he going to the bathroom every thirty minutes?”
[Here we have a] Five-year-old, circumcised, toilet trained (even at night) male with an apparent need to urinate multiple times during the day.
Once I have the urinalysis that is negative for nitrities and leukocyte esterase (thus no urinary tract infection), glucose (thus no diabetes), and blood (making stones less likely) and normal vitals coupled with a normal physical exam, it is really a matter of putting the issue into perspective.
“Your son has come to the realization that life is more interesting than standing in front of, or sitting on, a toilet.”
[This is similar to when parents report that their child does not eat their lunch at school as they are too impatient to go outside to play.]
As the maternal anxiety dissipates, it is replaced by considered curiosity. What to do? This is where I explain that a timer will help. Set a timer or watch alarm to alert every two hours as a reminder to “give a try in the bathroom.” A timer is not the nagging voice of a parent. It also is un-persuaded by animated games of Candyland or Minecraft. Off to the bathroom for another game: Battleship, also known as “Sink the Froot Loop.”
The main issue is that many boys don’t completely empty their bladders in their haste to return to the game or field or screen. Give them a couple of Froot Loops at which to aim (even push to generate a stream strong enough to break them up) and it’s a new game. Consider, I tell the parent, using Lucky Charms and they can also work on their aim, (always a selling point with moms) as they hit targets of different shapes.
“So what to do then,” inquired the mom, “in the case of a girl?”
“In that ‘sit’-uation, pun intended,” I offer, “I call it Submarine and tell her to work on her Kegel exercises.”
Mom is stunned. “You mean…those…Kegels?” she stammers incredulously.
I explain that identifying the muscles that start and stop a urinary stream voluntarily will increase the patient’s ability to control the urinary stream and facilitate more complete emptying of the bladder. The muscles of the pelvic floor are the ones that do this.
All in all, it is a pretty good appointment. Once a child can turn on and off the stream, they have learned how to “push” the urine out. There’s a lot more time between pit stops when you’re starting with an empty bucket.
So, the appearance of a bad beer in a urine sample is actually a cause for celebration. Couple it with some reassurance, a timer, a few bits of cereal, and those muscles associated with urinary control will be in (Battle) ship-shape in no time.”
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