A review of bowel and bladder control development in children: how gastrointestinal and urologic conditions relate to problems in toilet training.

Urologic and gastrointestinal problems in children are of great concern to parents. In most cases, such problems represent no organic disease or serious behavior disorder but nevertheless can cause more serious complications in toilet training than parents recognize. Although bowel and bladder symptoms in otherwise healthy children typically are transient, untreated issues can spiral into physical, behavioral, and developmental problems that disrupt toilet training and maintenance of bowel and/or bladder continence. Chronic wetting and soiling may persist well into the school years and often are refractory to empirical medical treatment. Clinical experience, however, suggests that in most children these problems can be managed successfully within the realm of general pediatric practice. Two important tools for evaluation are available to the pediatrician: good normative data on bowel and bladder function in children, and management algorithms for toilet training that emphasize pathophysiologic patterns within the context of normal development. Interventions emphasize early anticipation, breaking predictable behavioral and dietary cycles that can turn acute problems into chronic problems. This is especially important during the toilet training years.