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