SUBJECT: Bladder control

QUESTION: Our child, successfully toilet trained for many years, is suddenly having problems with bladder control. Is there any connection to his approaching puberty?

RESPONSE: The fact that this just began suddenly after years of being dry is concerning. He should have a urinary tract infection ruled out first (via a sample of urine sent for culture). If this is positive, he should have a renal (kidney) ultrasound, if not previously done, and a voiding cystourethrogram to demonstrate his internal anatomy and make sure there is no predisposition to a urinary tract infection. I would also make sure that there is no sexual abuse going on, since a sexually transmitted disease (possible to test for by cultures) could present with incontinence (lack of bladder control). A careful neurologic evaluation (physical examination) should be done to rule out a spinal cord problem (e.g. tethered spinal cord) and a spinal study performed, if needed. Finally, if all of this is negative it could be behavioral (anxiety, attention-seeking, etc.) and this could be addressed at home.

TK 5/14/02