Voiding school – treatment of children with urinary issues

After the age of three, most children start gradually controlling their bladder during the day, and somewhat later they also achieve dryness during the night. Occasional daytime or nighttime urine leakages or playtime voiding postponement still occur until the age of five. After they turn five or six, children are expected to have learnt a normal voiding pattern and will remain dry both during the day and during the night.

However, some children do not fully master the daily voiding routine even after the age of five. Urine may leak when they start playing and go to the toilet too late. Some postpone voiding for too long and eventually develop a lazy bladder. Apart from the uncomfortable situation of having visibly wet clothes and the unpleasant odour, they may also get genital inflammation and recurring urinary tract infections. Some also wet the bed at night. These problems are a sign of immature bladder control mechanisms, or that a behavioural pattern of proper voiding has not been learnt by otherwise completely healthy children over five. If the problems continue even after entry into school, this can be extremely burdensome and unpleasant for the child.

What can parents do?

Preferably, parents should recognise the problem and describe it to the child’s doctor. Nephrologists then determine whether the problem comes from not having mastered the daily voiding pattern, recommend Voiding school and issue an appropriate referral. The Nephrology Department at the Paediatric Clinic of the University Medical Centre Ljubljana is notified of all the steps in the process.

Voiding school at Rakitna

Voiding school is a fun and pleasant two weeks spent at Rakitna, with a weekend at home. The purpose of Voiding school is to teach the child proper voiding in a pleasant way, with positive stimulation and no unpleasant feelings. Every child is complimented already for a small success, and is encouraged and rewarded.

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The programme starts by explaining to the children that they are healthy and that urine leaks or other voiding problems are not their fault, it is only their little bladders that cannot yet deal with everything. Children learn to drink adequate amounts of fluids, to relax during voiding and to empty their bladder regularly and completely, and are provided with gymnastic exercises for the pelvic floor muscles. Children and their parents are first received by a doctor. Later on, children mostly work with nurses and teachers, while other important roles also include a psychologist, who builds the children’s positive self-image, a physiotherapist and sports educators. In the first week, the focus is on learning how to drink, and on regular and proper voiding. The second week is focused on fun recreational sports activities, with which children strengthen their pelvic floor muscles. Throughout the programme, children fill in their drinking, voiding and defecating diaries. On the last day, children receive diplomas, medals and rewards. At discharge, children and their parents talk to a doctor and a psychologist. At home, they continue with the measures they have learnt.

Will the programme help?

With further encouragement from a nephrologist and support from parents, results are excellent. A great majority of participants fully overcome the problems, and others diminish them greatly. After the voiding pattern has been learnt, problems very rarely reoccur.

 



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Dr. Anamarija Meglič, MD, paediatrician

Nephrology Department,

Paediatric Clinic, UKC Ljubljana