There are several reasons why children older than 4-5 years pee during the day. A common reason is that the nervous system that controls the bladder has not developed completely. Another is that the child forgets to pee. If the child kisses often or needs to go to the toilet very often, you should seek care.
This text is about children who are 4-5 years and older. After about 4 years of age, most children usually have learned to pee in a pot or toilet.
When the baby is peeing
When the bladder becomes full, signals are sent to the brain and the baby becomes pissed. The signals are controlled by the nervous system.
The bladder empties through the urethra. Around the urethra are muscles that open when the baby is peeing. The child controls these muscles with the will.
Various reasons why children pee
There are several reasons why children pee. Sometimes the child does not pee, but the hassles can be felt instead by peeing very often.
It is unusual for children to pee completely uncontrollably, without noticing that it is happening and without being able to interrupt.
Common causes are that
- the nervous system is not fully developed
- the child forgets to pee
- the child does not perceive the body’s signals
- the child has constipation
- the child has difficulty emptying the bladder.
The nervous system that controls the bladder is not fully developed
One of the most common reasons for children peeing during the day is that the nervous system that controls the bladder has not developed completely. The bladder can then suddenly contract without being full, and the child feels that they must urinate. In care, it is usually called that the child has an overactive bladder or an overactive bladder.
In some children, a splash of urine comes, while other children have learned to squeeze or squat and push the heel toward the urethra.
The child forgets to pee or cannot perceive the body’s signals
Another common reason for children not being able to get to the toilet on time is that they cannot receive signals from several directions at the same time. They pick out the signal that is not interesting. For example, when the child is preoccupied with play, they more or less consciously choose not to go pee.
The child has constipation
It is common for children who have constipation often feel pissed off. This is because the nerves of the intestine and bladder are close together. In constipation, the bladder cannot work as it needs. It also does not get enough space. Many people therefore pee.
The child has difficulty emptying the bladder
Sometimes the bladder is not completely emptied.
It can be labeled in several ways. For example, the child may have one or more of these symptoms:
- The child has a hard time getting started peeing.
- The baby needs to squeeze or press his stomach to get started peeing.
- The urine comes in small splashes, the baby often pee.
- The urethra is weak.
- It takes a long time to pee.
A common reason why the child cannot empty the bladder is that the child does not give himself time to pee clearly.
Another reason is that some children with overactive bladder learn to close the muscles of the urethra. The child does so so as not to have to pee so often. This allows the muscles in the bladder to push out the urine against a partially closed urethra. Then urine can remain and the bladder is not completely emptied. This causes the bladder to expand more and more. The child then does not feel as well when they need to pee. The muscles in the bladder become weaker and the baby pauses more and more rarely.
Sometimes the inconvenience may be due to the presence of bacteria in the bladder. For example, the child may have had a urinary tract infection. It is uncommon but sometimes the trouble can be due to congenital malformations of the urinary tract and neurological damage.
When and where should I seek care?
The fact that children are kissing on their own mostly goes by themselves. But sometimes the child may need to be examined.
You should seek care at a health care center or pediatric clinic if
- your child has been dry during the day but starts to pee during the day
- the child is peeing every day
- you suspect the baby’s urinary bladder is not draining properly.
Seek care directly at a health care center, emergency room or pediatric ward if the child pauses unusually often and a lot every time while being very thirsty and maybe even hungry and tired. It may be symptoms of type 1 diabetes.
What can I do for myself?
If the baby is peeing frequently and you suspect that the bladder is not completely emptied, it is good if they have time to pee properly. It can be good to sit down and pee to let it take the time needed. A recommendation for children may be to sit and pee first. When the child feels ready, stand up for a few seconds, then sit down and try to pee again.
You can talk to the staff in the preschool or school to make it as good as possible for the child. For example, it may be that they are helped to remember to go to the bathroom, or that someone is watching and waiting outside. Remember to talk to the child before deciding anything with the preschool or school. Let the child join the conversation if they wish.
Support for the child
It may be hard for a child to pee. Often it feels more difficult the older the child becomes. You as an adult can help the child by not shaming or embarrassing the child to kiss them. Saying, threatening, barking or teasing only makes matters worse.
You can try to help the child so that it does not smell, partly because other children should not comment on it. For example, you can make sure the child brings clothes for change when they are in preschool, school, at various activities or at others. With the child’s permission, you can also talk to the teachers, leaders, relatives or friends who are often with the child and can be helpful.
It is good to try to find out how often the child kisses and in what situations they kiss. You may also need to ask others, such as the preschool or school staff. Before a doctor’s visit, it may be good to keep a diary for a few days.
The child sometimes needs to be examined by a doctor
During the examination, the child and you will first be told about the problems the child has.
The doctor may need to see the orifice. It goes fast and doesn’t hurt. She can also look at reflexes by turning on the heel and looking at the child’s back, legs, and feet.
Often the child is allowed to submit a urine sample. For example, it can show if the trouble is due to an infection. Sometimes the child may also have blood tests. It can, for example, show how the kidneys work. The samples are usually answered within a few days.
Often, children are allowed to do a so-called urine flow measurement. The study is done to find out how the child is peeing. The child gets pee as usual but on a different toilet. The toilet measures how much, how fast and how long the child is kissing. Afterward, it is common for the doctor to check if the bladder is empty. It is done using ultrasound.
None of the exams hurt but may take some time. You may need to be at the reception for the exams for an hour or a little longer. It is usually good if the child is pissed off before the examination, then the examination can begin by allowing them to make a urine flow measurement.
Sometimes children need an x-ray to see how the bladder empties.
So you can prepare the baby at home
It is common to have thoughts and questions before the visit. Both you and the child may have thoughts and concerns. It is good then if you can prepare them and yourself for what is going to happen. It is important that the child knows why they come to the examination.
Children should be involved
There is no age limit when a child is allowed to participate in a care situation. The child’s right to decide for himself is related to the child’s maturity. The older the child, the more important it is for them to be involved in their care. In order to be active in health care and to make decisions, it is important that you understand the information you receive from health care personnel. You have the right to receive all the information you need from the healthcare staff.
Ask questions if you don’t understand. You can also ask to have the information printed to read it peacefully. If interpretation is needed in other languages, you may have the right to have it. You may also have the right to receive interpreting assistance in the event of hearing loss.
The older the child is, the more important it is that the child himself participates in discussions and decisions about the treatment. It becomes especially important during adolescence.
Treatment for children peeing on the day
The child can receive treatment with, among other things, bladder training and relaxation exercises. Sometimes medication is needed to help the bladder to relax.
Blistering calms down the bladder
The most common treatment of children peeing is so-called bladder training. It means that the child gets to practice peeing before they are kissed. This is done to soothe the bladder so that it does not contract.
The child learns how the bladder works and what needs to be done. She agrees with the doctor or nurse to go and pee at certain times at regular intervals. Toilet visits are adapted to the child’s daily activities. They may themselves be involved in deciding.
For the child to be motivated, they need to understand why they need to do certain things. Keeping a diary can make some children think it will be more fun.
Relaxation exercises can help
Sometimes the child may meet a so-called urotherapist, who is a specially trained nurse or physiotherapist. The child can learn relaxation exercises and various tricks to avoid the urinary bladder suddenly contracting.
You should get information about different treatments
The healthcare staff should tell you what treatment options are available. They should make sure you understand what the various alternatives mean, what side effects are available and where the child can be treated. This way you can help decide which treatment is right.
This is how the bladder works
The bladder is like an elastic sac, with walls of muscles. When the bladder becomes full, signals are sent to the brain that you need to urinate. The muscles of the bladder should be relaxed until you decide to urinate voluntarily.
The bladder empties through the urethra as you urinate. Around the urethra are muscles that you can pinch to stop the urine. With a will, you can both interrupt and continue to pee.
The muscles of the bladder need to be relaxed during the time the bladder fills. The muscle of the urethra should at the same time be tightened so that it closes. When the bladder is filled, the muscles of the bladder should contract to get the urine out. Then the muscle should be relaxed so that it is open.
The nervous system controls how the interaction between these muscles works.
In children, the nervous system is sometimes not yet fully developed. This means, for example, that the signal that it is time for the pee to be sent without the bladder is full. The child feels pissed and kisses.