Q. My 4-year-old daughter has just started preschool. The problem is that she is "not making it" to the restroom to pee. When I ask her what happened, she responds that she was playing and did not want to quit to go to the restroom. I am very concerned.
A. Forgetful pants wetting is a very common annoyance among preschool children. It's usually harmless -- more of a laundry problem than a medical problem. This type of pants wetting occurs more frequently among boys, since males of all ages tend to ignore their body signals. But holding the urine can increase the risk of urinary tract infections, which girls are more susceptible to than boys. So here's how to help your daughter recognize the signs that it's "time to go:"
Encourage her to drink lots of fluids. You might think this is the last thing she needs, but the more she drinks the more she'll have to pee. She'll get more used to feeling and responding to her bladder signals.
"Pre-pee." Tell your daughter that if she knows she's going to be playing for a long time, she should go to the bathroom and empty her bladder beforehand. Teach her to push the urine out completely by clinching her bladder three times after she has finished peeing.
Prevent constipation. The bladder and the bowels are anatomical neighbors. When the bowel is full, it exerts pressure on the bladder. The extra fluids you are giving her will help to empty the bowels. As will fiber, so add some natural laxatives to her diet. High-fiber juices and cereals, and lots of fresh fruit will keep the bowels from filling.
Drink cranberry juice. An eight-ounce glass of cranberry juice daily makes for good preventive medicine where there's a potential for urinary tract infections. Cranberry juice has an interesting biological quirk in that its nutrients inhibit the adhesion of bacteria to the lining of the bladder.
Wipe wisely. Urinary tract infections usually begin when bacteria around the rectum enters the vaginal opening and travel up into the bladder. To prevent this from happening, encourage her always to wipe from front to back and not to drag the soiled toilet paper over her vaginal opening.
Another way to help your daughter to listen to her body's cues is to show her how her urinary system works. I usually draw a picture to explain it to my children and my patients. Explain how the process works this way: "Your kidneys make your pee and they empty down long tubes into your bladder. The bladder is just about the size of a baseball. When it gets full, tiny sensors let the brain know 'I'm full. Please go to the bathroom.' But if you don't pay attention to what your bladder is telling your brain, the bladder gets lazy and quits talking to the brain and the brain quits listening to the bladder. Then you wind up with wet pants because the pee has to come out. If it stays in there too long, germs could grow in your urine and make you very sore." When children understand why their body signals occur and why it's important to respond to them, they take more responsibility for their toileting habits.