Our bladders rely on a good fluid intake to remain healthy. If children are not drinking well, they are more likely to become dehydrated, particularly if the weather is hot. This can impact children’s bladder health. Read on to find how to improve children’s bladder health during the summer holidays.

Dehydration may cause headaches, light-hot headedness, dizziness, lack of energy and make your child more grumpy than usual. It will also cause the wee (urine) to become more concentrated and darker yellow in colour. This is because the kidneys produce less wee as the body tries to hold onto water. Poos will also become drier and harder as the bowels hold onto water. This may cause constipation.

The bladder relies on regular emptying to help prevent urinary tract infections (UTI). If children are not drinking enough, they will wee less than the usual 5-7 times a day, and this may increase their risk of getting urinary tract infections.

Some children may limit their drinks, in the mistaken belief that they will not need to go to the toilet as often (particularly in school). However, the wall of the bladder is very sensitive and can become irritated by concentrated urine. If irritated, it will be less likely to hold on to the wee for a long time and may give the child less notice that they need the toilet. Families will often think their child is leaving going to the toilet until the last minute. They may also see their child ‘dancing,’ crouching, or holding their groin just before going to the toilet. Sometimes the child may end up needing to wee more than seven times a day, or they may get wet on the way to the toilet.

Not drinking very much or passing small amounts of wee frequently, because of bladder irritation or being sent to the toilet too often to try and prevent wetting, means that the bladder does not get an opportunity to stretch properly, so it may be smaller than usual. This can affect a child’s ability to achieve night time dryness as well.

Children who become constipated may also have problems with their bladder. This is because the end of the bowel (the rectum) is normally empty. The sensation of needing to have a poo happens as the poo moves into the rectum. If the signals are ignored for any reason, such as the child being unable to get to the toilet, or not wanting to go for any reason, the poo will stay in their rectum. If they continue to ignore the signals, they will become constipated. The poo that remains in the rectum takes up space that the bladder needs and puts pressure on the bladder, which then needs to be emptied at short notice and more frequently than is usual. If you think your child has a problem with constipation ask your child’s GP for advice.

Constipation may also be one of the causes of night time wetting for some children.  Another cause may be that the bladder is not able to hold as much wee as it should, something that can happen if a child is not drinking well during the day. More wee will be made at night if the child is drinking most of their drinks in the evening. This is one of the reasons why a good fluid intake, evenly spread out throughout the day is so important.

What should children be drinking?

Children (and adults) should be drinking enough water-based fluids that they do not feel thirsty. Children should be having a drink about every 1 ½ to 2 hours, until about an hour before bedtime. This is equivalent to six to eight drinks a day. The healthiest drink is water. The body uses milk as a food, so this is often not counted as part of the daily fluid intake. Fizzy drinks and drinks containing caffeine (tea, coffee, chocolate, cola and some energy drinks) can irritate the lining of the bladder and so make problems worse. They should be avoided.

Younger children need proportionally more water than older children, and older boys need more than older girls. Children who are overweight, who are in hot environments or who are very active need more as well. The recommended intakes of water-based drinks per day are:

• 1 – 3 year olds should have 900 – 1000mls
• 4 – 8 year olds should have 1000 – 1400mls
• 9 – 13 year old girls should have 1200 – 2100mls
• 9- 13 year old boys should have 1400 – 2300mls
• 14 – 18 year old girls should have 1400 – 2500mls
• 14 – 18 year old boys should have 2100 – 3200mls

During the school holidays it is easier to encourage children to drink. Reluctant children may drink more if allowed to chose their cup or glass, add ice cubes to their drinks, or play a game or read with their parents while drinking, or have dedicated drinking times with other family members.

How are children’s bladder problems treated?

Usually the first treatments tried in children with bladder problems are establishing good drinking and toileting routines. This is more difficult to do when children are at school, which is one reason why the summer holidays are a good time to work on bladder health.

What toileting routines help children’s bladder health?

Children with bladder problems should be encouraged to go straight to the toilet as soon as they feel the need to wee. They should also be asked to go to the toilet if their parents or carers notice them ‘dancing’, holding themselves or crouching. A good toileting routine would include them going for a wee about fifteen minutes after a drink, or about every two hours.

When children go for a wee they should be encouraged to relax and stay on the toilet until they are sure they have finished. Girls should sit with their bottom and feet well supported. Boys should stand and relax. They may find it helpful to sit to wee at least once a day, if they have any bladder problems. To poo both boys and girls should sit with their bottoms well supported, their feet flat on a firm surface and their knees higher than their hips. Most children will need a step under their feet to achieve this and many will need an insert seat.

In the summer holidays there is more time for children to get into a good routine of using the toilet, including having a regular time to poo. Children should also have open access to the toilet more often when they spend more time at home. They are not always able to have this at school.

What about treatments for bladder problems?

One of the most common bladder problems is bedwetting. In addition to good drinking and toileting routines during the day, going for a wee just before sleep and avoiding all drinks and food for an hour before going to bed are important. This can be easier to achieve in the summer holidays when there are fewer organised evening clubs and activities.

There are two main treatment options for bedwetting, either medication (usually desmopressin) or an alarm. Following an assessment your healthcare professional will decide with you and your child which would be the most suitable. The alarm is a device that makes a noise when the child starts to wee during sleep. The aim is to wake the child as they start to wet. Over time the child either learns to wake to the bladder signals and is therefore able to get up and go to the toilet, or they learn to sleep through the night, without needing to wee.

As the alarm is designed to wake the child, it will inevitably disturb their sleep. Getting up for school after disturbed nights is difficult. It is also harder to get up when the bedroom is cold, as happens in the winter. Therefore, summer holidays can be a good time to start using an enuresis alarm for children who have issues with bedwetting. It may take up to three months, or sometimes a bit longer, for an alarm to work fully. Therefore, by the time school restarts most children, where the alarm is likely to be successful, are already sleeping for longer before they wet and some may be having more dry nights by the time they have to go back to school.

Where can I go for further support and advice?

Although the summer holidays can be a good time to work on bladder health, by establishing good drinking and toileting routines and starting treatments such as enuresis alarms, families should not delay seeking support and advice if they have concerns at any time of the year.

If you are concerned about your child’s bladder health then discuss these with their GP, health visitor or school nurse. You may also contact the Bladder & Bowel UK helpline at bbuk@disabledliving.co.uk or telephone 0161 214 4591.

There is also lots of information about children’s bladder health and other conditions that affect children’s bladders and bowels on the Bladder & Bowel UK website at www.bbuk.org.uk