By Steve Hodges, M.D.
Recently on Quora, a mom posted this question:
My daughter's 1st-grade teacher refused to let her use the restroom. The request to use the restroom was made 3 times before my girl wet herself. Should we talk to the teacher?
The overwhelming response was: yes! Of course you need to speak to the teacher. I certainly agree and have written plenty about how school bathroom restrictions damage children’s bladders and bowels.
But that’s not my topic today. Instead, I’ll address some misinformation offered in a response posted by a preschool teacher. Suggesting the 1st-grader might have been faking the need to pee, she wrote:
I have a student who will literally (I kept a tally) ask to use the bathroom 48 times in 4 hours. This child does not have a medical condition. This child is not bored. This child just wants attention.
Whoa there! Any child who asks to use the bathroom 48 times in 4 hours does indeed have a medical condition. It is called urinary frequency, and it is caused by constipation.
I know it seems impossible that a child could feel the urge to pee that often, but in my practice, I see it all the time. Labeling these children bored attention seekers is not only unfair, but it also prevents them from getting the treatment they need.
Does Your Child Have Urinary Frequency?
You don’t need to count your child’s trips to the toilet to figure out whether you’re dealing with urinary frequency. With this condition you know it when you see it. These kids pee all the time, as often as every few minutes. This condition disrupts lives (theirs and yours), gets these kids in trouble at school (exhibit A: the preschool teacher above), and are stressful when your family is just trying to drive across town.
Parents understandably become alarmed when their child starts peeing more often than a pregnant woman and jump to the conclusion that he has diabetes. Indeed, excessive urinating is a symptom of type 1 diabetes, but I’ve tested hundreds of kids with urinary frequency whose parents feared diabetes and exactly zero were diabetic.
So what’s going on?
Urinary frequency has the same cause as bedwetting and daytime accidents: a pile-up of stool in the rectum is pressing against the bladder. The nerves that control the bladder essentially go haywire, sending premature — and terribly frequent — signals to the bladder that it’s time to pee.
The child may also experience a simple mass effect: The mondo load of poop crowds out the bladder so it can’t hold enough urine to last longer than a few minutes between voids.
In a smaller number of frequency cases, the poop mass encroaches on the bladder so much that it blocks the bladder outlet; the child can’t fully empty and therefore needs to pee more often.
Many children have both urinary frequency and accidents; in these cases, the bladder becomes so irritable that it sometimes empties instantly, before the child has a chance to get to the toilet. Other kids have the frequency without the accidents.
Urinary frequency typically shows up in 4-year olds, probably because it takes a year or two after potty training for constipation problems to reach a critical point. (Here I explain why preschool is prime time for kids to become constipated.) But kids of all ages can develop this problem. Urinary frequency is, for reasons unknown, more common in boys than in girls.
What baffles parents is the fact that the child is actually peeing — not just saying, “I have to pee.” So parents get the impression their child is turning out rivers of urine. One mom told me that every night after she put her 3 ½-year-old son to bed, he would come out to pee five or six times. She assumed he was just trying to get a reaction and told me, “How can a kid possibly produce that much urine?”
In reality, these children are just peeing smaller amounts more frequently.
How to Treat Urinary Frequency
If your child has urinary frequency, don’t panic. To be on the safe side, have a simple urine test performed on your child; this can rule out infection or the rare case of diabetes. But I predict the test will be normal.
At that point you can assume your child is constipated, but if you want proof, you can request an abdominal X-ray, called a KUB (for kidneys, ureters, and bladder). A rectal diameter exceeding 3 cm indicates constipation.
You can also refer to our 12 Signs a Child is Constipated and How's Your Poop? charts. Chances are, your child displays many signs besides frequency, such as extra-large poops and poops shaped like logs or pellets. Our book Jane and the Giant Poop will probably hit home, too!
Children who have frequency without accidents can usually be cleared out with a daily regimen of osmotic laxatives, such as PEG 3350 (Miralax), magnesium hydroxide (Natural Calm), or lactulose. These kids are likely to be cured more quickly — usually within a few weeks — than kids with frequency issues who also have daytime accidents and/or wet the bed. Those children need to be on the Modified O’Regan Protocol (M.O.P.), a regimen that combines enemas and laxatives and typically takes 3 to 6 months.