Bladder and bowel control

Both bladder and bowel control involve complex reflexes. Babies are born with the basic involuntary reflexes by which stretch receptors send nerve impulses to the spinal cord when the bladder or rectum is full. The spinal cord then signals to muscles in the bladder or rectum to cause these to contract, other muscles known as sphincters that control their openings relax, allowing urine or faeces to be passed.

However, these reflexes also have a voluntary or learnt component. As the spinal cord undergoes myelination and the muscles around the anal sphincter strengthen, the child becomes aware of and is able to regulate the timing of these reflexes in order to voluntarily control their bladder and bowel movements. This process takes time to learn and requires repetition, trial and error and involvement from carers in the form of a systematic programme of toilet training.

Most children learn to control their bowels between 18 months and 3 years old. They will usually have been walking for at least 6 months before this happens. Typically children become aware of and can control their bowels before they can control their bladder. The usual sequence is that they are clean before they are dry and dry by day before they are dry by night. In the U.K. 90% of children will be dry during the day by the age of 3.

Whilst bladder and bowel control rely on physical development, they are examples of how social, emotional, intellectual and language development all contribute to a child’s development.

Be aware

It’s important to remember that 21% of children aged 4½ and 8% of 9 year olds still wet the bed occasionally.

Intellectual

Children need to get used their body and its functions, associate physical sensations with the proper responses, picture using the potty, create a plan to get there, begin using it, and remain in place long enough to finish, which requires both memory and concentration.

Language

Many children will show by gestures or body language that they are aware of their full bowel or bladder before they have the words to make their needs known.

Emotional

Bladder and bowel control occurs at the same time as children are developing complex emotions such as pride, guilt and shame. These emotions depend on the child being self-aware and conscious of adult reactions. As such toddlers may become easily frustrated if parents become impatient or try and ensure they sit on a potty before they are ready.

Social

There is an enormous variation between cultures about when toilet training is carried out. The rituals around using a potty or the toilet such as pulling down pants and trousers, flushing and washing hands are also, in part, culturally determined, and will obviously vary between different countries. Most children learn these social skills by being told what to do and by the positive reactions when they achieve each step. They also learn by imitating siblings and parents using the toilet.