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Underlying causes of bedwetting

There can be underlying health conditions causing your child's bedwetting which need to be ruled out and treated if necessary.

Underlying causes of bedwetting include:

Constipation - if your child's bowels become blocked with hard poo, it can put pressure on the bladder and lead to bedwetting. Read about the signs of constipation and how it needs to be treated.

If your child has daytime bladder problems, this needs to be investigated by a healthcare professional first.

A urinary tract infection (UTI) can make your child's wee painful, causing frequency and urgency in their bladder.

Type 1 Diabetes. Alongside bedwetting, other symptoms of this can include feeling thirsty, frequent weeing, weight loss, hunger, blurred vision, tummy pain, vomiting, thrush and tiredness. You must take your child to the doctor if they have these symptoms to be tested.

When children have an additional need or physical disability, it's important their bedwetting should be assessed as it may not be related to their existing condition(s).

Get more information about the causes and treatment of bedwetting in our factsheet:   Advice for Children with Night Time Wetting

Sudden onset bedwetting

Secondary bedwetting (also known as sudden onset bedwetting) is when a child starts to wet again after at least six months of being dry.

The causes of this include:

An underlying health condition such as Type 1 Diabetes (see symptoms in section above). If you think your child could be diabetic, call your doctor so they can be tested.

Urinary tract infection or constipation, which both need treating.

Periods of change and stress in a child's life can also explain why they may suddenly start to wet again after even a long stretch of dryness.

Vasopressin, the hormone that controls how much wee we produce at night can be affected by anxiety. When children feel worried, they produce less vasopressin, so bedwetting is more likely.

Sudden onset bedwetting must be assessed and treated in the same way as primary bedwetting (when a child has never become reliably dry at night).

How to stop children wetting the bed

To stop bedwetting, first you need to know what the cause is, so the right treatment can be given.

The evidence shows the sooner your child is assessed and treated for bedwetting, the better chance they have of becoming dry at night.

NICE guidelines recommend that all children still bedwetting over age 5 should be given a bladder and bowel assessment by a healthcare professional.

Contact your GP for an appointment. There may be a bedwetting or enuresis clinic in your area that your child can be referred to.

Things to do before your appointment:

Check whether your child is drinking plenty during the day and what they're drinking

Make sure they are emptying their bladder before they go to sleep

Complete a night-time diary to record wet and dry nights

Keep a poo diary if you think your child is constipated

Our bedwetting animation explains more about the things you can try to improve your child's chance of being dry at night.

Using a bedwetting alarm

A bedwetting alarm is likely to be the ideal treatment for 'poor arousability' (when children find it hard to wake to a full bladder).

Alarms are a highly effective way of training a child to become dry at night but can be hard work at first.

Your child will need to feel motivated to stop bedwetting and mature enough to cope with the disruption. This is why it's important to talk to your doctor or nurse before trying this treatment.

How does the alarm work?

A bedwetting alarm has a sensor attached to an alarm. When the sensor gets wet, it sets the alarm off, and this should wake your child up. Over time, the alarm helps your child to learn when they need to wee and wake up to go to the toilet.

We sell a wide range of body worn and bed mat alarms in  our online shop.

Alarms aren't available on the NHS, but you may be able to borrow one from your local enuresis (bedwetting) or continence clinic.

Alarms and children with additional needs

There are alarms available for children with additional needs which vibrate and flash. These can be less frightening for a child on the autistic spectrum, for example.

Get more information about using an alarm and the different types available.

Bedwetting alarm tips

Bedwetting alarms need to be used for at least 4 weeks. They rarely work straight away. This is because your child needs to get used to waking up and responding to it.

It's a good idea to encourage your child to practise setting off the alarm before they go to sleep so they know what to expect.

Explain to your child what needs to happen when the alarm goes off e.g. get out of bed, go to the bathroom, change their pants/pyjamas and strip the bottom sheet.

You may choose to sleep in the same room at first, so you are near in the night when it goes off and whilst your child is learning what they need to do.

How will we know it it's working?

At first, your child may empty their bladder before they respond to the alarm. Over time, they will learn to stop the flow of urine when the alarm sounds.

Progress might just be smaller wet patches at first. Try to keep going until you've had 14 dry nights in a row and then you can stop.

If there's been no progress after 12 weeks, stop the treatment and have a break for a few months before trying again.

It can take 2 - 3 months on average for a child to be consistently dry at night. Some children will take longer.

More tips for using an alarm

Reward your child for drinking well during the day and for helping change wet bedding rather than for keeping their bed dry (this is beyond their conscious control).

Avoid only rewarding nights when they don't wet the bed.

Clean the sensor every morning to prolong its life. Replacement sensors can be bought from our shop.

If your child wets more than once a night, you will need to re-attach the alarm to clean underwear after each wetting episode. As your child makes progress, the nightly wetting episodes will decrease.

Even if your child is sure they will no longer wet the bed, encourage them to continue to wear the alarm until they have had 14 dry nights in a row.

Children occasionally have another accident after they appear to be able to stay dry through the night. If this happens, use the alarm again until they have achieved another 14 dry nights.

Stopping using the alarm before your child is fully dry at night can lead to a relapse.

Bedwetting medication

If a bedwetting alarm doesn't help or isn't suitable for your child, treatment with medicines is usually recommended.

Your doctor may suggest a medicine called Desmopressin. Given an hour before sleep, it works by 'topping up' the body's levels of the hormone vasopressin and tells the kidneys to produce less wee at night. It can be taken regularly or just for nights away.

Get more information on using desmopressin as a treatment for bedwetting.

If desmopressin or a bedwetting alarm (or a combination of both) doesn't help, your child may be referred to a specialist, who may recommend other medicines.

Managing bedwetting day to day

Wetting at night is not as big a problem if you can find ways to manage it. Here are some things to try:

Before your child sees a health professional, encourage them to get into good bladder and bowel habits: Make sure they poo regularly (at least 4 times a week) and treat any underlying constipation.

Assess and treat daytime bladder problems first (wetting accidents or urgency for example).

Drink plenty during the day: 6 - 8 glasses of water-based fluid is best. Only have a small drink before going to bed if necessary and ideally stop drinking an hour before bedtime.

Make sure your child fully empties their bladder before they go to sleep.

Move them to the bottom bunk from the top if they share a room. Have a night light and bucket to help if they wake in the night for a wee.

If they wear a pull up at night, have a trial of a few days without one on. Make sure your child understands what they need to do in the night and their bed is well protected. A waterproof under sheet makes changing the bed much easier and saves washing the lower sheets.

Reward your child for drinking well during the day and for helping change wet bedding rather than for keeping their bed dry, which is beyond their conscious control.

Think positively; they can try repeating the phrase "I can be dry!" as they get into bed.

Tips for nights away from home

Bedwetting shouldn't stop your child from joining in with camps and sleepovers.

Here are some tips for a stress free night away:

Reassure your child that wetting the bed is common and the chances are they won't be the only one on the trip who has wetting accidents.

Be prepared. There are lots of products that can help such as pads, pull-ups, sheet covers, special underwear and sleeping bag liners.

Desmopressin can be taken for a one off trip, but your child would need to try it beforehand to work out the right dose and make sure it helps them to be dry.

If your child is taking a sleeping bag they could hide a pull-up or pad at the bottom.

If their underwear or pyjamas are also inside the sleeping bag, they can get dressed for bed in private.

Bedwetting and younger children

There isn't a fixed rule about when to stop using nappies at night as every child is different. If your child can stay dry during a nap, or for 2 or more hours during the day they may be capable of staying dry overnight.

Helping your child master daytime potty training will have taught them many of the skills they need to stay dry at night.

Here are some tips to promote night time dryness in under 5s:

Make sure your child is drinking enough in the day and try to avoid large amounts of fluids at bedtime.

Stop drinks an hour before bedtime OR plan to help them use a potty at night (e.g. if your child is breastfeeding at night).

Help them get into a routine of using the potty or toilet before they go to sleep.

Protect the bed with a waterproof sheet and try putting them to bed without a nappy to see how they manage.

Expect some accidents and understand that these are a very important part of the learning process.

Some children may need to use a potty at night, so make sure you have a potty in their room if possible and a gentle light by the bed.

If your child wakes up at night, help them to use the potty or toilet.

Bedwetting and teenagers

It's common for older children to deny their bedwetting and not want to talk about it with you. Hiding wet sheets can be a way of coping with the embarrassment they feel. It's happening outside their conscious control, and they may secretly worry about it.

There are ways to support your child to manage their wetting such as keeping a diary of wet versus dry nights to see if they can spot a pattern.

If treatments aren't working, ask your doctor or nurse to make a referral for your child to be seen by a specialist.

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Bedwetting - reasons and how to stop it - ERIC

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Information to help work out why your child is bedwetting and how to stop night-time accidents including information about alarms and medication.

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Nap times

Once your child has stopped using nappies in the daytime, it's time to think about nap times.

Learning to sleep without a nappy on at naptime and use the potty when they wake up, will help prepare your child for being dry at night.

Tips for managing nappy-free nap times:

Just before nap time, help your child use the potty or toilet, so they are more likely to stay dry.

When you notice the nappy is staying dry at least some of the time, stop using a nappy at nap time.

Accidents are common during the first few months. Use a waterproof sheet or similar underneath your child, to protect their sleep area.

Lots of children need to use the potty when they wake so help them to do this.

Using praise and rewards to motivate your child

Research shows that rewards such as sweets or sticker charts may help your child initially, but they can stop working quickly.

For most children, encouraging and supporting them to be as independent as possible is the best way to motivate them.

Tips for keeping your child motivated:

Give your child plenty of encouragement and praise their efforts. When your child uses the potty or manages to stay dry, even if it's just for a short time, tell them how pleased you are.

Try to stay calm when accidents happen and do not make a big fuss.

Give your child the opportunity to do things for themselves as far as possible. This will help them to feel in control, positive and relaxed about the process.

Use favourite toys, books or songs to help them feel comfortable on the potty.

Try to avoid prompting or asking your child too often. Instead, wait until you think they need to go and then direct them gently, e.g. "it's toilet time" or "let's get that wee/poo in the potty!"

Be clear, confident and consistent so your child knows what you are asking them to do.

Managing potty training accidents

It is normal to have lots of accidents at the beginning and they are an important part of the learning process. This is a big step for your child, so be patient and encourage them.

Tips for managing accidents:

When your child has an accident, clean it up together and remind them to use the potty next time.

Do not shame or punish your child about accidents, as stress and upset can make it harder for you and your child to learn together.

It's important not to pretend an accident hasn't happened. Help them get clean and dry as soon as possible and involve your child in this process. Gently explain that you want them to use the potty next time.

Potty training out and about

When you first stop using nappies, choose a time when you can stay home with your child for a few days, so you can do some one to one learning with them.

Tips to make your first trips out easier to manage:

Don't forget your potty and spares of everything just in case!

Make trips out short to begin with.

Dress your child in clothes that are easy for them to push down and pull up again.

Avoid putting your child back in a pull up or nappy for outings. This will confuse them and undo all that learning.

A travel potty and washable car seat cover can come in handy.

Using the toilet away from home is a good thing for your child to get used to. Talk to them about things like how the flush at the supermarket is different from the one at home or nursery for example.

We have an excellent range of products to help with this stage including portable potties and car seat covers.

Potty training at nursery & pre-school

Many children spend part of their day being looked after by someone other than you and away from home.

For potty training to go well, your child needs a consistent approach to help them learn what they need to do whether they're at home or in childcare.

As soon as your child starts attending the setting, communicate about their bladder and bowel health. Ask the staff to tell you about the child's poos, so you can keep track and avoid constipation.

Find out what they are offered to drink to you can supplement appropriately at the beginning and end of the session. If the setting will only offer water, and your child is reluctant to consume enough water, talk to staff. Offer to supply juice or squash for them to dilute; it is vital for your child to stay well hydrated when they are away from home.

Start conversations about potty practice as soon as your child can sit up. Settings may regard potty training as something to attempt when the child is older; share this information so they too can see the benefits of potty practice.

When you are thinking about stopping using nappies, plan with the staff. Agree dates together with your child's caregivers so everyone is ready to support them. Time what you are doing at home to fit in with the setting.

Avoid starting to wear pants when the child is about to change rooms at nursery - that will be a big enough upheaval for them.

Tell the staff about the language you use at home for wee and poo.

Talk to the staff at the beginning and end of each session so everyone knows how things are going both at the setting and back at home. Use our potty training record so staff can keep track of their progress.

More information and free resources for childcare settings to support potty learning.
Getting dry at night

The age at which children become dry at night varies hugely. For some, it follows on quite quickly after achieving daytime dryness. For others, the wetting carries on after the age of 5 and treatment will be advised.

It is not your child's fault if they wet during sleep.

There are however lots of things you can do to gradually work towards night time dryness including:

Help your child get into the habit of using the potty or toilet at bedtime.

As well as making sure they are drinking plenty during the daytime, work on a good bedtime drinking routine as well. STOP drinks one hour before bedtime, every night, and no more after that till morning. Our Wee Checker has information on how much children should drink for their age.

Prepare your child for sleep. Unwind with a book or listen to music with the lights turned low. NO screens - so no TV, iPad, computer games in the hour before sleep, or the brain will get the wrong message!

Avoid lifting - in other words waking your child to take them to the toilet - if you want to work on stopping bedwetting. It might keep the bed dry, but it encourages the child to wee during sleep as they don't really wake up.

If your child is still wetting the bed when they are 5, see our Advice for Children with Night Time Wetting factsheet for more information and help.

Common potty training problems

Taking your time leading your child through the preparation and practice stages should help to avoid the most common potty training problems.

If you feel as though it's all gone wrong and they're just not getting it, it's ok to stop, go back to the preparation stage and start again.

Could they be constipated?

Constipation affects 1 in 3 children and is especially common in under 5s. Your child may be struggling because they have some underlying constipation that was there before you started potty training.

So stop, treat the constipation and then try stopping the nappies again once it is all under control. Carry on with potty practice - this in itself is an important part of constipation treatment.
Are they drinking enough?
Sometime the bladder misbehaves and we realise that our child is simply not drinking enough.

Once again, you don't have to go right back to the beginning, but go back to the potty practice stage while you increase your child's fluid intake.

Try not to panic if it seems as if they just aren't getting it. Some children take longer to learn, and just need more time.

Reassure your child that their wees and poos will learn to go in the potty, they just need more practice!

Get more information and help with common potty training problems.

FAQs

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Potty training: how to start & best age to potty train - ERIC

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We've broken down potty training into 3 easy steps: preparation, practice and perfecting those skills! Use our step by step guide to help your toddler become toilet trained.

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Here's how constipation can cause soiling accidents:

When underlying constipation isn't diagnosed or treated properly, poo stays in the bowel and rectum longer than it should.

This poo becomes harder as water is absorbed by the body.

As fresh poo arrives, the rectum stretches and becomes a 'loading bay' for lots more poo. A poo traffic jam has happened.

Soft runny poo can then leak round these lumps and bits of hard poo can break away into their underwear.

When the bowel gets overstretched, a child can stop feeling the urge to pass a poo. It also makes it harder for them to fully empty their bowel when they go to the toilet.

Soiling accidents can easily happen because of a poo traffic jam.

Is soiling a sign of another condition?

Soiling is a physical problem which is nearly always caused by underlying constipation. Soiling rarely happens for psychological, behavioural or emotional reasons.

Other possible reasons for soiling include:

Rarely, there can be a physical cause of soiling, but these are usually diagnosed at birth or soon after.

Children avoiding doing a poo because they are worried it will hurt.

Feeling nervous to use a toilet away from home.

Not being allowed to use the toilet when they need to go, at school for example.

Being distracted when watching TV or playing a computer game.

Food allergies or toddler diarrhoea can cause soiling, but these reasons are less common.

A short-term illness such as a tummy bug.

How do you treat soiling?

The advice for treating soiling is the same as relieving constipation in children.

Your child needs to be seen by a GP who can prescribe laxatives to clear any lumps of poo.

For more information about treating soiling, see our advice for children with constipation. It explains how laxative treatment and a toilet routine can help a child who is soiling.

How can soiling affect a child's behaviour?

Soiling is nearly always caused by a physical rather than a psychological or behavioural problem. However, the stress of living with this issue can cause behavioural changes in children.

It can have a big impact on their mental well-being, education and friendships. Imagine trying to manage a physical problem (constipation) you have no control over?

Poo accidents can make children behave in various different ways including:

Hiding their underwear. It's very common for children to act as if they're not bothered by their poo problem because they find it embarrassing and feel guilty.

Being angry and defensive. Not knowing how to resolve a physical problem such as soiling can cause children to feel stressed and sad.

Going into denial. Some children won't even be aware they have a problem because to them it feels 'normal.' We don't always notice our own smell so they may genuinely not know they've had an accident.

Try to stay calm and don't shout or punish your child if they have a soiling accident. Remember: they are not doing it on purpose.

Can a child recover from soiling?

Yes. With the right treatment a child's bowel can recover allowing them to poo normally again.

These children are likely to become constipated again so it's important to use our poo checker to keep an eye on their bowel movements and follow these everyday tips:

Make sure your child they has at least 6-8 water based drinks every day.

Include fruit and vegetables in their diet.

Encourage them to follow a regular toilet routine: sitting on the toilet or potty after every meal and using a footstool to support their feet.

Give them plenty of opportunities to exercise and move around.

Don't stop giving laxatives too early.

Resources

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When underlying constipation isn't diagnosed or treated properly, poo stays in the bowel and rectum longer than it should. This poo becomes harder as water is absorbed by the body. As fresh poo arrives, the rectum stretches and becomes a 'loading bay' for lots more poo. A poo traffic jam has happened.

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How often should a breastfed baby poo?

Babies who are fed breast milk usually pass softer poo more often than those who are formula fed.

The 'on-demand' way breastfed babies tend to feed and the milk they get means that their poo is usually runny and golden in colour. It also doesn't smell too strongly.

They may poo several times a day, especially in the first few weeks of life. After a month or so the frequency may reduce; they may even go a few days without a bowel movement.

Breast milk is designed to be easily digested so there might not be much waste. As long as your baby is growing well, gaining weight and their poo is soft, you don't need to worry.

How often should a formula fed baby poo?

Formula-fed babies' poo tends to be firmer, darker brown and stronger smelling than breastfed babies. Some formulas can also make your baby's poo a different colour such as dark green.

If you change from breast to formula feeding, your baby's poo is likely to become darker and more paste-like.

Constipation is quite common in formula fed babies. If your baby is struggling to poo, changing their formula may help, but this should only be done after talking it through with your GP or Health Visitor.

Talk to your GP or Health Visitor if you have any concerns about their feeding or pooing.

Tips for helping your baby to poo

A relaxing warm bath can help to get poo moving.

Gentle tummy massage - watch this video to see how to do this safely

Bicycle leg exercises - lay your baby on their back and gently move their legs in a circle/bicycle motion. This will help their stomach muscles to move and put gentle stimulation on their bowels.

If your baby is already eating solid foods then diluted fruit juice, such as apple, pear or prune, or the fruit itself can help to stimulate their bowel. Fruits, such as apples, pears and prunes, contain sorbitol. This is a natural laxative, helping the bowel retain water, which helps their poo stay soft and easy to pass.

Starting solid food (weaning)

Weaning changes poo. Once your baby starts on solids, their poo will smell stronger and be less easy to wipe.

As they begin to try a bigger selection of foods, their poo becomes thicker and darker.

More fibre-rich foods will pass straight through your baby, until their digestive system has developed enough to deal with them properly.

Potty training

Before your toddler stops wearing nappies, there are lots of skills for them to learn with your help to make the process easier.

We have lots more information and support about how to prepare your child for potty training.

Making sure your toddler is drinking enough and they're passing a daily soft poo will make toilet training a lot easier.

It's important to get any underlying constipation treated before you stop using nappies as it will make the process difficult.

Constipation in babies and toddlers

Constipation can start at any age and is particularly common in toddlers especially at the potty training stage.

Recognising the signs and symptoms of baby constipation means you can avoid it becoming a 'chronic' problem and get the treatment your baby needs.

If you think that your child may be constipated, use our poo diary to track how often they are pooing. Our poo checker shows the different types of poo and what they mean:

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Baby and toddler poo - what to expect - ERIC

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Babies who are fed breast milk usually pass softer poo more often than those who are formula fed. The 'on-demand' way breastfed babies tend to feed and the milk they get means that their poo is usually runny and golden in colour. It also doesn't smell too strongly.

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Many people, of all ages, find toilets unpleasant and sometimes worrying. It is particularly common in children and can impact on their bowel and bladder control and function.

It is important to recognise toilet anxiety or toilet phobia in children and the effect it can have on them, so that they can be supported to overcome their fear. This can avoid further problems developing and focuses on the underlying cause.

What is anxiety?

Anxiety is the emotional response to an unfamiliar or alarming situation, and is linked with physical changes in the body. It is a normal response which can help us learn and adapt - you may have heard it described as 'flight or fight'.

It can sometimes be fun and exciting, such as in stories like 'Going on a Bear Hunt' or whilst watching films, like Star Wars. New situations can often make children anxious, but this feeling usually reduces quickly and they start to feel better.

What is toilet anxiety?

Toilet anxiety, toilet phobia or paruresis may be triggered by an unpleasant experience, such as a noisy or smelly toilet. Children might remember this each time they go - leading to an association of anxiety with going to the toilet. They may also start to hold in wee or poo to avoid using the toilet.

This can lead to constipation as the poo is not let go and this can result in a large uncomfortable poo, causing even more increased anxiety. Memories of an unpleasant or painful poo, following constipation can last for a long time, even if the poo has returned to normal so the anxiety may continue.

Anxiety following an unpleasant experience can be hard to forget and overcome. It can also continue to affect children's confidence and behaviour.

Fear of toilets is often about the unknown, and may be linked to imagined monsters and scary things, snakes in the toilet, and dangerous germs (Toilet cleaners 'kill all known germs' after all!).

Physical effects of anxiety

These may include:

Nausea and stomach ache

Rapid shallow pulse

Rapid shallow breathing (even triggering an asthma attack if children have this).

Headaches

Wee and poo accidents

Faints

Emotional effects of anxiety

These might include:

Panic attacks

Tantrums and meltdowns

Withdrawal

Freezing

Sleep problems and nightmares

Irritability

Clinging

Distress and exhaustion

Denial and resistance to engage with the problem

Possible causes of toilet anxiety

New, unfamiliar toilets

Constipation and/or a painful poo

Soreness and skin inflammation round the anus or round the urine outlet

Different clothes e.g. pants which may be different and feel strange

The sensation of wee and poo coming out and losing part of yourself

Splash back from the toilet

Will it stop?

Feeling that they could fall into the loo

Background factors

Individual personality

Family changes and stress e.g. new baby, moving house

Potty training (this is the first time a child needs to actually engage with their wee or poo)

Starting school and/or nursery
Being denied access to the toilet at school

Being called names or bullied

Inability to cope with new situations

Trauma

Health issues

Developmental conditions e.g. autism (ASD)

Children with concentration difficulties (ADHD,ADD)

Sensory factors

Many children may be upset by too much sensory stimulation including:

Visual - bright lights, reflections, glare

Hearing - echoes, sounds of toilet filling and/or flushing, hand driers

Touch - the feeling of the toilet seat, toilet paper, clothes being down round the legs

Smell - highly perfumed bathroom products and cleaners, the smell of poo

Balance - feeling of unsteadiness especially on a strange or different toilet

Proprioception - understanding where your body is in space and in relation to the toilet

Interoception - understanding and feeling the sensations from inside the body, including sensations from bowel and bladder activity

Responding to sensory factors

Analyse the toilet environment

Reduce the amount and impact of unpleasant sensations

Make the bathroom familiar and friendly, with games music and pictures

Provide distractions and more stimulation for those who need it

Our sensory factsheet has lot more information on supporting children with sensory needs.

How to stop toilet anxiety in children

Accept and recognise the child's anxiety and analyse the factors contributing to this.

Check bowel and bladder function. Many children are constipated too and that will need treatment before progress can be made. See our advice for children with constipation for more information.

Build confidence with other activities and skills e.g. washing hands, putting on socks, being helpful

Break up the task into small, easy steps that can be gradually built on

Use predictable routines

Distraction

Try to make toileting fun

Talk to the child about anxiety

Some things to try

Music and songs

Videos which explain how toilets work

Tactile activities e.g. fiddle toys, putty, play dough

Joke book - laughter is a great way to relax children

Visuals e.g. kaleidoscopes, spinning danglers

Gentle massage, tummy, feet or hands

Sounds e.g. waves, music, bird song

Slow, deep breathing

Thinking about a favourite place or activity

Using rewards

Reward effort as much as success

Keep rewards small and fun

A lucky dip box

Activities and targets for older children

Peace and quiet may be preferred by some children.

Things to avoid

Giving unrealistic targets

Asking too many questions- use "I wonder what..."?

Getting cross - but you can be cross with the wee and poo coming out in the wrong place! Talk about how annoying it is that the wee/poo is misbehaving again, and how you and the child will have to teach it how to behave.

Other things to consider and try

It's always important to consider and assess anxiety

Try to see the situation from the child's perspective

Toilet anxiety may be linked only to toileting activities

Anxiety improves with experience and familiarity

Parents and carers need support too, it is stressful dealing with an upset child

Consider and discuss school toilets

Make sure children get used to other toilets (these can be scored out of 10).

Remember: Anxiety usually improves with experience, support and growing up.

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Toilet anxiety and toilet phobia in children - ERIC

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Why the bathroom is frightening place for some children and how we can help them overcome their fears.

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Stool withholding is particularly common when children are potty training. It can also affect children who have an additional need such as autism. It's an issue which can cause a huge amount of stress and confusion to parents.

Some children also hold on to their wee. Many of the same strategies listed here can help with wee withholding also.

Read on to find out why it happens and how to help your child overcome poop holding.

What is stool withholding?

Stool withholding (sometimes also called poo holding) is when children avoid passing a poo.

They use their bottom muscles to stop themselves from having a bowel movement when they feel the urge to go.

Why is your child holding poop?

Withholding usually follows on from a period of constipation. Passing just one painful or uncomfortable poo, even as a baby, can scare a child and trigger a physical reaction. It can happen without parents realising.

Other common triggers for poo withholding include:

An illness such as a virus, with a high temperature and sickness that can lead to dehydration. Dry poo is harder to push out and will hurt more.

Passing a bigger than normal poo (known as a mega poo) can make a small tear in a child's bottom called an anal fissure. This can make pooing very painful and something they want to avoid doing again.

It is very common for children to start holding on to their poo when they begin potty training.

A change in routine and using a different toilet away from home at nursery or school for example.

Lots of children would prefer not to poo at school and then become constipated as a result.

Signs that your child is poo holding

There are lots of different signs and clues which show your child is trying to stop a poo from coming out. These include:

Looking like they are straining on the toilet, when they are actually trying to stop themselves from passing a poo.

Asking for a nappy back on to poo. We have a factsheet for more help with this.

Refusing to sit on the toilet/potty when you ask them to.

Stopping suddenly during play and making unusual facial expressions such as grimacing.

Holding their bodies in strange positions (a banana bend), going rigid and standing on their tip toes.

Seeming vacant and not responding to instructions. It can take a huge amount of effort and concentration to hold on. Your child may get cross if you interrupt them at this point or seem 'unreachable'.

Going into denial. You child may say: "I don't need a poo and I haven't had an accident" when you can clearly smell that they have! This is a classic stress response to a situation they feel embarrassed about but don't know how to stop or control.

'Smudges' of poo in their pants or nappy.

Hiding in a favourite, safe space like behind the sofa or wrapped up in curtains when they feel a poo coming.

Some may sit on the toilet or potty and make grunting noises that sound like 'pushing' but this is actually them using all their effort to keep their bottom firmly closed.

Crouching or sitting when they feel a poo coming and then standing up quickly to prevent it coming out.

Pooing in their night nappies or night wear, is another sign of stool withholding. Once your child relaxes in bed, they can no longer hold and the poo escapes. We don't normally poo the night because our bowel isn't being stimulated by food and drink.

What can happen when children hold their poo?

When children stop the urge to do a poo it's very easy for them to get trapped in a vicious circle of withholding. When their poo hurts or they are fearful of the toilet, they find it hard to relax and are anxious it will hurt.

Children then try to avoid going for a poo and it hurts more.

This cycle of holding poo can quickly mean a child becomes constipated.

How to stop stool withholding

Breaking the stool withholding cycle needs a two pronged approach - sort the physical first and then you can work on the behavioural side effects of being scared to poo.

Here are our top tips to break the habit:

You must treat the constipation first

When your child's poo is reliably soft, you can start working on reassurance and confidence building.

Take time to make sure your child is relaxed and comfortable in the bathroom - there are lots of tips to help with this on our page about toilet anxiety.

Your child needs to believe that their poo will not hurt them anymore. Many children will not trust it when they are told their poos are ok now, they need to feel it for themselves. Take a look at our information on supporting children who feel scared of poo.

Stay calm and do not get angry with your child.

Try to see it from their point of view - we all avoid things that hurt us, but as adults we have learnt about consequences and can understand the risk of long term effects.

It's really important to remember that children don't soil or withhold on purpose or to be naughty.
Resources

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Stool withholding: why & how to stop a child holding poo - ERIC

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Find out the reasons why poo withholding happens and how to help your child overcome this stressful cycle of behaviour.

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Holding on to wee is something young children can get into the habit of doing especially when they're potty training.

It's not as common as ' poo holding', but can still be a worry if your child avoids emptying their bladder for long periods. The good news is it's very unlikely to do any long term damage to their bladder.

Find out more about why children sometimes hold their bladders and how you can help them to stop avoiding the toilet.

What is wee withholding?

Children's bladders work best when they are fully emptied on a regular basis. Normal bladder emptying (also known as 'voiding') is around every 2/2.5 hours hours in school aged children.

Babies and younger children often pass urine more frequently whilst their bladder is growing and they are potty training.

Some children hold their pee for long periods and overstretch their bladders. Other children get into the habit of an 'abnormal voiding pattern'. They find it hard to relax their muscles when they do sit on the toilet and this affects their ability to wee normally. The different parts of their urinary tract system stop working together as they should.

Why is you child holding their bladder?

Reasons for wee withholding include:

Constipation and having an overloaded bowel can squash a child's bladder and stop it from being able to fill and empty properly. Check if your child may be struggling with constipation and find out how to treat it.

If your child withholds their poo, they may start to hold their wee too. By sitting on the toilet for a wee, they are more likely to feel the urge for a poo, or some stool could force its' way out. By avoiding sitting at all they are still in control.

Being away from the comfort of home and family when starting nursery, school or another childcare setting. As the periods of time become longer, the holding can become more of an issue. A child may hold on all day at nursery for example and only do a wee when they get home.

If your child has had a urinary tract infection (UTI), they may associate the pain they had with weeing, so avoid passing urine even after any infection has been treated.

Pain and discomfort when passing a wee can also be felt if your child isn't drinking enough. Their urine can become strong and may sting, so they avoid doing a wee.

Being denied access to the toilet at school. Get more help with this on our school toilets information page.

Wee withholding cycle

Just like when children hold on to their poo, avoiding doing a wee can lead to other problems and so the cycle goes on.

Holding is likely to overstretch the bladder, it also makes the child more likely to develop a urinary tract infection. The more concentrated and painful their wee is to pass, the more a child tries to avoid weeing all together.

How to stop wee withholding:

The pattern of wee withholding can be changed back into a normal one by encouraging your child to wee at regular intervals and fully empty their bladder.

Get more information and help with this in our advice for children's daytime bladder problems.

If your child has been unable to wee for some hours and is getting uncomfortable, seek medical help urgently.

Other ways to help your child:

If their problem began due to poo holding/constipation and is still a problem for your child, this needs to be treated first.

Look at that toilet environment, have a conversation your the child about the toilets.

Having a wee is easier when you are relaxed rather than tense. Help your child to relax on the toilet, make it more comfortable with their feet supported on a stool. Try having music playing, reading a story together or singing a song.

When we blow, whilst sitting comfortably on the toilet, it helps us to empty our bladder and bowel. Blowing a windmill, instrument or even feathers on cotton lengths may help them start to wee and with emptying. There are lots of ideas in our blog about relaxing on the toilet.

If your child is more sensitive to things like smell, touch, sound or visual inputs, there's lots of information in our Toileting and Sensory Needs resource.

Some children find having a wee whilst in the bath is easier, this is a great temporary solution, but obviously will not be possible away from the home.

Some children have difficulty starting a wee. It may help to use a bladder stimulator - a vibrating device they can hold over the full bladder whilst sitting comfortably on the toilet. Hesitancy should be assessed by a Health Care Professional first.

Can wee withholding cause long term bladder damage?

Wee holding is a habit that the child is likely to grow out of with time, but is something that can and should be treated before having a effect on your child's bladder health.

Holding is likely to overstretch the bladder, it also makes the child more likely to endure a urinary tract infection and also it can lead to kidney damage due to the back pressure.

Please be reassured however, that if this issue does not continue for too long, it won't have a long term effect.

Further help

If you have any concerns about your child's bladder health, please book an appointment with a doctor or nurse.

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Holding on to wee is something young children can get into the habit of doing especially when they're potty training. It's not as common as ' poo holding', but can still be a worry if your child avoids emptying their bladder for long periods.

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Potty training children with additional needs - ERIC
Almost all children can learn to be clean and dry. Children with special needs including delayed development and physical disabilities may take a little longer and need more support. However, the process you need to follow is the same. This can feel like a big challenge, but it's important not to put off potty training for too long

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Almost all children can learn to be clean and dry. Children with special needs including delayed development and physical disabilities may take a little longer and need more support. However, the process you need to follow is the same.

This can feel like a big challenge, but it's important not to put off potty training for too long. The longer your child wears a nappy, the harder it may be to introduce a new place for them to wee and poo.

There's information and tips on this page to support children with additional needs and sensory issues.

How to potty train your child with additional needs?

We recommend breaking potty training into stages and tailor your approach on their abilities.

Our 3 step Let's Go Potty approach has been developed to suit all children and abilities. This includes children with autism, ADHD, developmental delay, cerebral palsy and Down Syndrome.

Potty training with autism

There is no evidence that suggests autism causes delayed potty training. However, autistic children may be more likely to struggle to learn potty training skills due to sensory problems or learning disabilities.

They may also be more likely to suffer from constipation. If your child is autistic, research suggests that starting learning in infancy and avoiding constipation is the best way to avoid problems in the future. Get more information about supporting autistic children who have constipation.

One of the hardest things for many autistic children to cope with is a sudden change in routine or habit. This is why the more you can do before you stop using nappies the better, to help make this transition as gentle as possible for them.

Our Let's Go Potty approach has been designed to help your child make this transition whatever their needs are.

Potty training and delayed speech

Non-verbal and neurodivergent children can't always communicate their thoughts and feelings. This means you can't rely on their signals to tell you when they're ready to potty train.

You may need to take more responsibility for knowing how often your child goes for a wee or poo and using this to help direct them.

Here's what we recommend doing to help your child learn this skill:

Complete a bladder/bowel assessment chart so you can see how often they are doing a wee or poo. (Make sure any underlying constipation is treated.)

Base your potty or toilet routine based on this information. Take them at set times according to what the chart tells you.

If they wet themselves at another time, take them to the toilet as quickly as possible and try to get them there so some of the wee goes into the toilet. Ignore the wetting and positively reinforce that the wee has gone into the toilet and continue the rest of the toileting routine.

Use verbal and visual clues. Introduce simple books on the subject consistently using the signs, sounds or words that your child can use. Reinforce verbal clues with a visual clue - use photos, drawings, pictures, images and social stories when preparing them to use the potty. Using these images to create visual schedules will make it easy for your child to follow the new routine and make it more predictable.

Using sign language for common toileting words and phrases can also reinforce learning.

Potty training children with Down syndrome

We are delighted to be partnering with Down Syndrome UK and Positive about Down syndrome to share their fantastic #Pants4school Step by Step Programme. Enabling children with Down Syndrome to be toilet ready for school and reach their full potential.

Download the programme today! (opens in new browser).

Tips for children with additional needs

Your child may take longer to learn each stage, so consider your expectations and don't rush the learning.

Focus on one stage at a time. For example, teach them that poo goes down the toilet by flushing it away together.

Be as consistent as possible. The more consistent you are, the easier it will be for your child to learn.

It's important that your child feels relaxed, comfortable and secure about using the toilet or potty. Make sure the space is accessible to your child. An Occupational Therapist (OT) can help with practical adaptations.

Think about your child's sensory needs and how these relate to using the bathroom. Adjusting the sensory input can make a difference for many children to help them to learn toileting skills.

If you start with the toilet you should use a footstool to help your child feel confident and safe. This will also help your child get into the best position for doing wees and poos, with their feet supported and knees above hips.

Help your child learn the physical skills needed by breaking them down into smaller steps and allowing your child to do the last step independently. For example, help them push their trousers down most of the way, then have them push the last bit down themselves. Same when pulling them up again.

Encourage independence as soon as you see it developing, phasing out support once your child shows competence.

Use stories, visual charts, props and games to teach your child what to do and how to do it. Make your own learning aid by taking photos of your bathroom, drawing pictures of the steps, or by searching on the Internet for visual routines. A standard routine could be: 1.Undress 2. Underwear down 3. Sit 4. Do wee/poo, 5. Wipe, 6. Pull up underwear, 7. Pull up trousers/dress, 8. Flush toilet, 9. Wash hands.

Give your child positive encouragement and praise for the efforts they are making, not just the result. This can help to keep them motivated and willing to move to the next step.

FAQs

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Potty training children with additional needs - ERIC

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Information on potty training for children with additional needs and sensory issues including delayed development, ASD and physical disabilities who may take a little longer to become toilet trained.

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Potty training problems - ERIC
Following the steps and tips in our Go Potty™ method should avoid many common potty training problems. However, all children are individuals. Some adapt to learning new skills without any problems, whilst others take longer and have some problems along the way. Don't forget that accidents are an important and normal part of the learning process.

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Following the steps and tips in our Go Potty™ method should avoid many common potty training problems. However, all children are individuals. Some adapt to learning new skills without any problems, whilst others take longer and have some problems along the way. Don't forget that accidents are an important and normal part of the learning process.

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Bowel and bladder issues such as daytime bladder problems, bedwetting, constipation and soiling can have a devastating impact on a child’s learning, development and well-being.

For many sufferers their continence problem will be 'chronic' - meaning it could persist for many years or keep recurring.

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Health risks

Banning toilet breaks during lessons or restricting access to the toilets can aggravate or even create continence problems.

Consequences can include:

Individual Healthcare Plan for pupils with continence conditions

An Individual Healthcare Plan (IHP) is essential to ensure a child's needs are sensitively and effectively met in education settings and that all people responsible for the child understand their needs.

ERIC has produced a template IHP with input from Dr Eve Fleming, a community paediatrician and Brenda Cheer, a Paediatric Continence Specialist Nurse. The plan was reviewed by a school nurse, a paediatrician, and two families of school-age children with continence problems.

Download the template Individual Healthcare Plan.

Toilet access

Some children struggle with a bladder condition which means they need to wee urgently and frequently, others may have a bowel condition such as constipation.

When these children need to wee or poo, they have to go and shouldn't be told to 'hold on'. If they're afraid to ask to go to the toilet or the toilets aren't a pleasant place to be, this can make their continence problem worse and reduce their ability to manage or overcome it.

For small children it may negatively affect their ability to learn to use the loo.

Access to toilets in primary school

Find out what the arrangements are for children to get permission to use toilets during class time.

Children, especially younger ones cannot be relied upon to need the toilet only at set times like playtime and lunchtime and so there needs to be a certain amount of flexibility for them to go outside these set times.

Unfortunately we know some schools may take a fairly inflexible approach to this, and in reception in particular, this isn't appropriate for this age group.

Children will usually need to ask permission to leave the classroom, but can be nervous about asking out loud or worry about interrupting the teacher. If this is the case, speak to the teacher about a more discreet system for your child to alert the class teacher that they are leaving the room such as placing a magnet on the whiteboard or a codeword or hand-signal they can use.

Improving school toilets

The condition of toilets at school can be a key factor in how willing children and teenagers are to use them.

Unfortunately there are very few legal minimum requirements governing children's toilets in schools in the same way that there are for the staff that work in the school.

But it's really important that children should be able to use toilet facilities that are clean and that feel safe to use.

Here are our suggestions for what to look out for:

With the right design, layout and choices of finishes and fixtures, school toilets can be attractive, safe, durable and low maintenance. Open, bright and attractive toilets will encourage pupils to value themselves and their facilities.

The 'Toilets in Schools' guidelines, published by the Department of Education in 2007, show how toilet design can be improved to address a number of common failings in school toilet provision and includes strategies for effective maintenance and operation of toilets.

The legislation that covers school toilets and washing facilities is the Schools Premises and Regulations (SPRs) 2012.

How do you get a toilet pass at school?

Since the passing of the Children and Families Act in 2014, education settings have a statutory duty to support children with health conditions, including bowel and bladder problems.

If a pupil has an identified continence issue that the school is aware of, they should be given a 'toilet card' or similar that allows them to go to the toilet when they need to.

The school may ask for a signed letter from a health professional requesting that a child has a condition which means they need a 'toilet pass'.
Download our sample toilet pass (PDF)
Can schools lock toilets?

Many schools around the UK have a policy of locking school toilets during lesson times, with some even keeping them shut during breaks between classes. In schools where the toilets are locked, pupils sometimes have to request a key before they can use them.

Unfortunately, there's no law stopping schools from locking toilets during lessons, but that doesn't mean they should do it! Banning toilet breaks shows a lack of understanding of pupils' health needs and a lack of respect for children.

For a child with urgency problems, this is not a feasible solution.

This policy also singles out pupils with bowel and bladder conditions - when they may want to keep their condition private - as they are the only pupils allowed to use the toilet during lessons.

What can your child do if their school locks the toilets?

Sample school toilet policy

A written school toilet policy:

indicates to pupils and parents/carers that the school values and respects the welfare of its students by fulfilling their right to go when they need to,

shows that all school staff follow the same approach to school toilets and their access,

means pupils know when they can use the toilet and aren't left worrying whether they'll be told off if they ask to go during a lesson,

encourages schools to audit the toilets properly so they don't deteriorate over time; and

ensures pupils' needs are fully taken into account.

Pupils should be actively involved in creating and implementing the policy. It should be approved by pupils and governors, communicated to the whole school and reviewed each year.

Not sure how to start writing a policy? We've done the hard work and produced a template school toilet policy for you.

Download the template school toilet policy.

School toilet charter

Download our School toilet charter

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School toilet policy: rules and regulations - ERIC

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Banning toilet breaks during lessons or restricting access to the toilets can aggravate or even create continence problems. Consequences can include: An Individual Healthcare Plan (IHP) is essential to ensure a child's needs are sensitively and effectively met in education settings and that all people responsible for the child understand their needs.

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Constipation in children: symptoms, causes and relief - ERIC

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We explain how to spot constipation in children, understand the causes and how to relieve the symptoms of constipation.

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Toileting advice for children with additional needs

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Toileting advice for children with additional needs

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Desmopressin for bedwetting – Medicines For Children

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This leaflet is for parents and carers about how to use this medicine in children. Our information may differ from that provided by the manufacturers, because their information usually relates to adults. Read this leaflet carefully. Keep it somewhere safe so that you can read it again.

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Constipation and smearing in children and teenagers

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Find out about constipation and smearing in children and teenagers. Learn about the symptoms, possible causes and how to treat constipation.

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Use our poo diary to record your child’s bowel movements. This is a useful resource to track constipation and bedwetting.

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The Poo Nurses explain disimpaction using macrogol laxatives - ERIC

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ERIC is a company limited by guarantee registered in England number: 2580579
Registered Charity Number: 1002424

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Bristol Stool Chart  Simple Measures CCS

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Advice on Bladder and Bowel Problems in Children and Young People

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Children and young people Bladder and bowel health Issues affecting the bladder and bowel are very common in children and young people. Here you can find specialist advice to help. varied issues The problems can include difficulties with toilet training, wetting and/or soiling.

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Individual care plans for intimate care in schools

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Individual care plans for intimate care in schools

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A template form for families and schools to identify and agree practical help that a student with a continence condition needs at school