Parents may also have to explain their child’s condition and associated care to school, extended family and others who look after their child, such as out-of-school clubs or nurseries.

What is often forgotten is that a bladder or bowel condition in one child can affect other children in the household as well. It is not easy to invite friends to play or to sleep over if you are worried about any lingering smells at home due to episodes of incontinence, or how others may react to a brother or sister’s toileting routine. There may be anxiety that if friends find out that a sibling has a bladder or bowel issue, they may tease or bully both the affected child and their sibling. Many children will also be conscious of the additional pressure that managing the bladder or bowel issue causes for their parents.

Difficulties managing journeys and finding appropriate places to clean and change a child who has experienced urinary or faecal incontinence, and any associated embarrassment or perceived stigma, may limit the activities that a family feel confident to do. This may result in all the children missing out on holidays, day trips, visits to wider family and friends’ homes or other outings that their peers take for granted.

Children who have bladder and/or bowel issues are more likely to struggle with self-confidence and self-esteem, and there may be psychological impacts from the issue, but these may also affect the child’s brothers or sisters. They may become upset when they realise that their brother or sister should be clean and dry, or if they perceive others are responding negatively to them due to the wetting or soiling. Parental attention may be focussed on the child with the problem: on the practicalities of managing, attending appointments and undertaking recommended treatments. This may result in parents having a reduced capacity to provide support and attention to other children in the family.

Different rules about what is acceptable for different children within a family may be difficult for young people to understand. Differing boundaries may give rise to disharmony and feelings of neglect or resentment and may induce anxiety in other children. Occasionally, younger siblings of the affected child may respond by regressing in their own toileting.

The way that families approach managing bladder and bowel symptoms can help all the children in the family. When families understand that children do not wet or soil to be naughty or because they are lazy, but because they have an underlying problem, then the first steps can be made to work on a solution.

Talking to all the children about the issue, what is thought to be causing it and things that can be done to help, will reduce any feelings of isolation that the affected child has and allow their brothers and sisters to offer support, encouragement and to feel involved. This positive response may also eventually help to reduce the taboo in society on discussing bladder and bowel health issues.

Healthy eating, drinking and toileting habits are often recommended as first-line interventions for both bladder and bowel issues. All children in the family can be involved in these and in offering support and encouragement. Positive role modelling and motivators for all the children to exhibit desired behaviours can create a sense of solidarity and involvement.

Other children in the family should not have to provide direct care to the child with the issue, but some may want to be involved and offer practical, as well as moral support. They may also be able to give different perspectives about how the child is managing when away from home e.g. in school or when with wider family members.

Every child and family are different. Therefore, how bladder and/or bowel symptoms in one child affect the other members of the family will be unique. Some basic principles that can help other children in the household feel included and helpful are:

• Ensuring that all the immediate family know how the bladder and bowel work and how to promote bladder and bowel health.
• Provide opportunities for children to ask questions, to be involved and to help support a sibling who is affected by a bladder and/or bowel condition.
• Seek support from your child’s school nurse, health visitor or other healthcare professional who can help you support all your children when one of them has a bladder and/or bowel issue.

For more information about bladder and bowel conditions in children and how they may be managed please visit the Bladder & Bowel UK website.