help4yourfamily

Older Kids with Bathroom Issues: Why does it happen? How Can You Help? Part 1

White Toilet Bowl in Malaysia (Photo credit: epSos.de)

written by, Kate Oliver, MSW, LCSW-C

No one wants to talk about it. It’s a messy issue, and it stinks…literally. In my practice I see quite a few children who, at a much older age than usual, have bathroom issues, where either they wet themselves at night or during the day. Some even soil themselves. It is often a difficult issue for parents to bring up, and there I times I have seen a child for months before anyone is even willing to mention it, even though it is one of the questions I ask during my initial parent visit for children with attachment related issues. Many of the parents that come to me say it is the most embarrassing of all the issues their child has. It is also the thing that can make parents angry the fastest. After all, if you have a ten-year-old who just wet themselves in your car, it is easy to forget that there might be more going on than lack of self-control. Instead, we tend to focus on the fact that your car smells like urine and a ten-year-old did it!

When a child has a behavior like enuresis (wetting themselves during the night or daytime) or encopresis (soiling themselves), I always look for the root cause. It is important to know where this problem starts because often by knowing where something starts, we can figure out how to fix it in the most loving way possible. In this post I am going to focus on daytime wetting and soiling, as I believe that bed-wetting is an easier issue to find information about and can have a different origin than daytime wetting and soiling which I see most often in children with a history of trauma and neglect.

In my next post we will look at solutions to these problems. Until then, here is a list of questions to help you think about the origin of your child’s issue because when we know the origin, often the solution becomes clear.

1. “Has my child seen a doctor about this issue?” The first place to start with any problems involving the bladder is always with your child’s doctor. Even if your child has not been complaining about a bladder issue. Even if you asked them all the questions that go along with having a bladder infection, still go to get tested. This is important especially if your child has a history of neglect, since they will be more likely to be out of touch with their bodies so they may not be alert to discomfort until it is a major problem. Additionally, even when there is a mental health issue related to a child’s enuresis or encopresis, some children require a medical intervention because, especially for a child that holds on to bowel movements (bm’s), there can be a cycle of holding onto bm’s followed by a painful releasing that can require medical attention in order to stop the pain that reinforces the holding of the bm’s in the first place.

2. “Was my child properly potty-trained?” This may seem like a strange question to ask if you have an eight-year-old, however, if your eight-year-old was being potty trained by an abusive, and or actively drug-using parent, child-care worker, grandparent, etc. during the time when children normally get potty-trained (anywhere from 2-4.5 years old) then they may not have been taught in the ways that they were able to understand. It may be that no one ever walked them through proper wiping procedure after going to the bathroom. It may be that no one ever taught them how to tell if they need to go. Your child may have a developmental lag in this area because they were not able to “master” the developmental milestones that go with being properly potty trained. Additionally, if your child was not properly trained, they may not have developed the muscles that we do not even think about which we use everyday to control our bladder that keep us from our own embarrassing issues.

3. “Does my child have trauma associated with the bathroom?” It may be that your child avoids that bathroom because some bad stuff happened in and/or related to a bathroom at some point, or, they may have experienced trauma related to wetting or soiling themselves. Potty training is reported to be the developmental step during which a child is most likely to experience abuse. If you have a child who has experienced trauma, ask yourself if they may be avoiding the bathroom because it reminds them of something they would rather not think about. Maybe it was a place they hid from someone. Maybe it was a place where they or someone else they loved got hurt. Maybe they were beaten or threatened with harm if they had an accident during potty-training. For children with severe trauma, it may be that they experience a “trigger” wherein they feel terrified, and/or they may be experiencing a traumatic reenactment wherein they are re-experiencing a traumatic situation as their brain’s way of making sense of it and the experience is so intense that they end up peeing on or soiling themselves. An example I have often used comes from when I was a kid myself:

One night I woke up to a small fire in my room. No one was hurt and the house survived but it was scary. The fire truck came and it was pretty clear that things would have been way worse had I not woken up when I did.

Many years later when my children were very small, I remember taking my daughters out to play in the snow. It was a cold day and several people had made fires in their fireplaces. When I went to enter my own home (where we did not have a fire lit), I had a moment when the smell of smoke hit my nose, probably from a nearby chimney. I handed my youngest daughter to my husband and yelled, “Stay out of the house, there’s a fire!” Then I proceeded to run into the house, looking for smoke so I could see where the fire was.

Because I am telling you this story, I’m sure you have figured out by now that there was no fire, however, I can tell you that at the moment I entered my home, I was 100% certain that there was. The smell of smoke was the trigger and I responded accordingly. While it did not involve a wetting or soiling incident (lucky me) I think it does describe how our brains can get tricked for a moment into thinking something is happening again, even when it is not. As I said before, this can sometimes happen with enuresis and encopresis in children of all ages.

4. “Is my child pissed off?” Well, what is the best way to show someone that you are pissed off? Some of the kids that come to see me, intentionally urinate or defecate either on themselves, the furniture, or even mom’s prized photo album. If a child has not been given the tools to express feelings in a reasonable way, they express them in whatever way occurs to them at the time.

Any survivor of abuse or neglect that has not had adequate opportunity or support to process the impact of the trauma often carries an intense level of anger or rage inside. When the anger is not addressed, it comes out in other ways. Even though I have had parents report to me that their child does not act angry when they are urinating on furniture, it is possible that a child with an attachment disorder would seem relatively calm while seething with rage underneath. I liken it to the times when I have gone to the ocean and the lifeguards warned people not to go in the water because the undertow is too strong. The waves look the same to me but there is a pull underwater that you cannot see and that can carry you away from safety. Whether it is because they were not allowed to express feelings for fear of harm, or they gave up on expressing feelings because their feelings were not honored anyway, some children learn that the most effective way to express how they feel is by urinating or defecating intentionally.

5. “Is my child fearful of connection to others?” For children with attachment disorders, it is not uncommon for a child to make themselves seem repellent. I hear a lot about children who refuse to bathe even though they smell terrible, or who have disgusting habits that repulse their parents. If a child is fearful of connection, then feels connection despite that fear, they may do something to make themselves feel more comfortably distant. I see this sometimes when a child comes into my office and we have a moment when the child connects to her mother. Maybe she says something nice about her mom, or they share a hug. For a child where connection is terrifying due to early abuse or neglect, they may subconsciously find a way to reestablish a distance between themselves and their caregivers by wetting or soiling.

Now that we are getting curious about the origins of encopresis and enuresis in older children, in my next post, I will address what we can do about enuretic and encopretic older children.

Related articles:

Older Kids with Bathroom Issues: Why Does it Happen? How Can You Help? Part 2 (help4yourfamily.com)

Caught in the Loop: Why People Repeat the Same Bad Choices Over and Over (help4yourfamily.com)

Parent Affirmation Monday- Curious (help4yourfamily.com)

Chronological Age vs. Developmental Age (help4yourfamily.com)

January 24, 2013 - Posted by help4yourfamily | attachment disorder, child development, discipline, mental health | Child, Diurnal enuresis, Encopresis, Enuresis, Health, Nocturnal enuresis, Urination, Wetting