Urine Accidents and Stool Withholding

At an age when a child is expect­ed to be toi­let trained for urine (by age 3–3 ½), wet­ting dur­ing the day may be attrib­uted to active urine with­hold­ing. The uri­nary blad­der has a lim­it­ed capac­i­ty to store urine. When the vol­ume of urine retained in the blad­der over­comes that capac­i­ty, the blad­der will go into spasm, result­ing in small urine acci­dents. The under­wear may be damp, not nec­es­sar­i­ly soak­ing wet. The child may smell of urine.

Urine with­hold­ing rep­re­sents an extreme­ly con­trol­ling behav­ior and like stool with­hold­ing, is an active process that a child exhibits while awake. Urine with­hold­ing is usu­al­ly seen in asso­ci­a­tion with stool with­hold­ing. Fre­quent­ly, when a child is eval­u­at­ed by a urol­o­gist for urine with­hold­ing, the urol­o­gist look­ing at an x‑ray of the abdomen, will detect sig­nif­i­cant fecal impaction and refer the child to a pedi­atric gas­troen­terol­o­gist for treatment.

Present­ly, there is no spe­cif­ic med­ical ther­a­py to over­come urine with­hold­ing behav­ior.  In the child who is stool with­hold­ing as well as urine with­hold­ing, res­o­lu­tion of stool with­hold­ing may improve the urine with­hold­ing.  With an increase in stool­ing, as the result of lax­a­tives, the child will have uri­na­tion at the same time as defe­ca­tion, thus decreas­ing the vol­ume of urine with­held.  Wet­ting inci­dents will diminish.

Fredric Daum, MD