Bladder and bowel conditions are among the most common health problems in children and a cause of anxiety for their families, but there are many professionals and places you can turn to for help and information.

Incontinence (leakage of wee or poo), difficulties with toilet training, or other issues with toileting can result in difficulties at home, nursery, school or in the wider community. They are a source of stress and frustration for families, not only due to the difficulties of practical management of ‘accidents’, but also because of the impact on your child.  

Children who are struggling with learning the skills required for toilet training, or who have toilet trained but have new or continuing wetting or soiling (urinary or faecal incontinence) are often embarrassed and upset about the problem. However, some children will behave as if they do not care about an issue that they cannot control. This may make you feel the wetting or soiling is deliberate, laziness, or naughty behaviour. This is very rarely the case. Childhood incontinence, or issues such as appearing to leave it to the last minute to go to the toilet, is nearly always caused by a bladder and/or bowel health problem. Most of these can be successfully treated. 

Wetting and/or soiling in children and young people may be associated with emotional problems, difficulties with mental health, poor self-esteem and reduced social opportunities. Furthermore, the additional washing and clothing needed may be expensive. Therefore, it’s important you know where to turn for more help and information.  

In this blog post, we outline what you should be able to expect from the different professionals who may work with you and your children within health or education.  

Nursery

Nurseries should ensure that all children in their care are kept safe and supported to learn and develop according to their individual needs. This includes providing support for bladder and bowel health. 

• It is reasonable to expect nursery to support the needs of your child, as an individual, whilst in their care and review this support regularly.  
• Staff at nursery should be trained in supporting you and your child with learning the skills that they need to be successful with toilet training. You should not be expected to wait until a particular age for this. 
• Healthcare professionals can train nursery staff to complete any procedures your child needs for their bladder or bowel health e.g. catheterisation. 
• If nursery identify a cause for concern, they should discuss this with you and suggest that you contact your local GP or health visitor for further assessment, advice, and support.  

Health visitors

Health visitors are qualified nurses that sit under the umbrella of universal services. This means they should be available to all families with children who have not yet started full time primary school. They work to identify health needs as early as possible and to improve young children’s health. Your health visitor should meet you when your baby is about ten days old. They will see you either at home, in a local child health clinic, or at your GP surgery. 

• Health visitors should be trained in children’s bladder and bowel health and assessment of any possible issues.  
• Health visitors are often the first point of contact for assessment and guidance of your child’s bladder and bowel issues.
• It is reasonable for these health professionals to discuss your child’s bladder and/or bowel issues with their GP. They may also, with your consent, talk to other professionals supporting you with your child e.g. social worker or family support worker or other healthcare professionals.  
• Once they have completed their assessment they will work with you, your child and your child’s GP to provide a plan of care. This may include some treatment or referral for more specialist support. 
• You should be provided with verbal and written information about your child’s bladder or bowel issue and any treatment options.

School nurses

School nurses are trained nurses that are also part of universal services and work with children aged 5 -19 years old. They work in schools and other settings to promote health, identify health needs and offer suggestions to prevent health issues getting worse. They can also refer to other services as required. School should be able to provide you with information about how to contact your school nurse.  

• School nurses should be trained in children’s bladder and bowel health and assessment of any issues. 
• You can contact your child’s school nurse if you have any concerns about your child’s bladder and/or bowel. 
• If your child is at secondary school, they may be able to ask to see the school nurse at a regular ‘drop-in’. They do not have to say why they want to see the school nurse.  
• They should be able to offer initial assessment and suggestions to help. 
• The school nurse may discuss your child’s bladder and/or bowel health with their GP. They may also ask your consent to talk to other professionals who are supporting your child e.g. social worker, family support worker, other healthcare professionals.  
• Once they have completed their assessment they will work with you, your child and  your child’s GP to provide a plan of care. This may include some treatment or referral for more specialist support. 
• You should be provided with verbal and written information about your child’s bladder or bowel issue and any treatment options. 

General Practitioners

General Practitioners (GPs) are doctors who treat common medical conditions and can also refer on for more specialist advice and treatment if this is required.  

• You can contact your GP if you have concerns about any aspect of your child’s bladder and or bowel health. You do not have to have seen a health visitor or school nurse first. 
• Your GP will review any assessments completed by your child’s health visitor or school nurse, if you have already spoken to them, and discuss with treatment options and provide general lifestyle advice to help. 
• It is reasonable to expect that they may wish to complete a face-to-face physical assessment of your child. This may include examining their tummy or asking for a urine or stool sample.   
• Dependent on your child’s condition and/or progress they may refer your child for further assessment and treatment with another health professional in a specialist service. This can be a specialist nurse, therapist or paediatrician. Referrals may take some time as many services are very busy and have long waiting times. 
• You should be provided with verbal and written information about your child’s bladder or bowel issue and any treatment options. 

School or collage

Schools or colleges are often able to identify health concerns in children and young people. They should discuss any such concerns with you and they may also ask the school nurse for support and advice.  

Schools have a duty to support children and young people with medical conditions. There is more information about what you can expect from school if your child has a bladder or bowel issue in the guidance: Managing Bladder and Bowel Issues in Nurseries, Schools and Colleges.

• Professionals in school such as your child’s teachers, teaching assistants, special educational needs coordinator (SENCO) may raise any concerns with you.  
• Education staff may ask for the school nurse to contact you and request consent to assess your child or they may ask you to contact the school nurse or your GP, and, as appropriate, seek further advice from your GP regarding your child’s continence. 
• Schools must make reasonable adjustments to meet your child’s bladder and bowel needs whilst they are in their care. This includes during school trips and sports sessions 
• Schools should provide safe, clean, and accessible toilet facilities for your child. They should allow them access to these as required. 
• Schools should allow children and young people to drink water regularly during the day, to ensure they stay well hydrated.
• It is reasonable to expect that school will discuss a care plan for your child with you and with your child if this is appropriate for their age and development. 
• School may request that other professionals involved in your child’s care contribute to any care plan to ensure that your child’s needs are met, and difficulties addressed promptly. 
• School may request support and training from a specialist team, if they are involved with your child’s care and your child needs support for interventions that need to be carried out in school e.g. catheterisation or stoma care. 
• Schools should be able to make suggestions about where you can get further information and support about your child’s bladder and/or bowel issue.  

Specialist services

Specialist services for children and young people’s bladder and bowel health vary across the UK. Some areas have a nurse-led, community-based children’s bladder and bowel service. Where these are not available your child may be referred to a paediatrician at their local hospital, if it is felt that a specialist service is needed.  

• A specialist service will assess your child’s bladder and bowel health. It is likely this will involve asking lots of questions about their general health and usual bladder and bowel habits. You may be asked to complete some forms that include information about their drinking and toileting patterns.  
• The service should explain what they think is causing any bladder and/or bowel issues and may provide written information about this and any treatment suggestions. 
• The specialist service may make suggestions about drinking and toileting routines and other lifestyle adjustments that may help. They may also recommend other treatments. 
• The service should offer regular reviews and treatment adjustments after discussion with you and your child (depending on their age and level of understanding) until the bladder and/or bowel issue has resolved.  
• Some children may require onward referral for further investigations and treatment options. Reasons why this may be recommended should be discussed with you and your child if required.  

Further information

There is more information about children’s bladder and bowel health and problems on the Bladder & Bowel UK website.