Understanding continence in school-aged children and teenagers
Older children and teenagers with cerebral palsy (CP) may have problems with bladder and bowel continence for many reasons. Continence means being able to control wee and poo. For some children and teenagers with CP, continence skills may take longer to develop or may need extra support.
Bladder and bowel difficulties can be linked to movement, muscle control, communication, learning, constipation, bladder function, medication, pain, fatigue, or difficulty getting to and using the toilet. These issues can affect comfort, confidence, school participation, social activities and quality of life.
Urinary incontinence means having trouble controlling wee. It may come and go, or it may happen more often. Your child or teenager may have:
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An overactive bladder or urge incontinence, where they feel a sudden or frequent need to wee and may leak before getting to the toilet
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stress incontinence, where leaking happens with coughing, sneezing, laughing or exercising
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overflow incontinence, where the bladder does not empty fully and leaking or dribbling occurs
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functional incontinence, where it is difficult to get to or use the toilet because of mobility, clothing, transfers, communication or access barriers.
Daytime wetting can also be linked to constipation, urinary tract infections, stress, changes in routine, or major transitions such as moving from primary school to high school.
Bowel problems can include constipation, soiling or difficulty doing a poo. Constipation is common in children and teenagers with CP. It can be linked to gut movement, reduced mobility, tight or weak muscles, diet, fluid intake, some medicines, pain when doing a poo, or difficulty sitting comfortably and safely on the toilet.
Constipation can cause:
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tummy pain
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discomfort
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poor appetite
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nausea or vomiting
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soiling
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urinary tract infections
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more problems with bladder control
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difficulty with some medicines being absorbed properly.
It is helpful to keep track of bladder and bowel patterns. This may include how often your child or teenager wees or does a poo, whether accidents happen, whether poo is hard or painful to pass, and whether they avoid using the toilet.
It is important to talk to your healthcare team if your child or teenager has continence concerns. Support is available, and the right assessment can help identify what is happening and what strategies may help.
A continence nurse, urologist, paediatrician or allied health professional can provide assessment and support. Depending on your child’s needs, the team may also include an occupational therapist, physiotherapist, dietitian, psychologist or school support staff.
A continence plan may include:
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regular toilet routines
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constipation management
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support for drinking enough fluid and eating enough fibre
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toilet seating and positioning
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equipment or clothing changes
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communication supports
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school toilet access plans
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pelvic floor exercises, if appropriate
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medication or other treatments, if needed.
Some children and teenagers may need more specialised treatment, such as bladder medication, biofeedback training or surgery. These options are usually considered after assessment by the right health professional.
The aim is to support comfort, dignity, independence and participation at home, school and in the community.