Keeping your child's bladder healthy

This information from Great Ormond Street Hospital (GOSH) explains how to keep your child’s bladder healthy, reducing the risk of urinary tract infections and other problems with weeing.

The urinary system consists of the kidneys, the bladder and ureters. The kidneys filter the blood to remove waste products and form urine. The urine flows from the kidneys down through the ureters to the bladder.The ureters tunnel through the wall of the bladder at an angle to form a flap that acts as a valve. There is also a ring of muscle (sphincter) at the junction of the bladder and the urethra that stops urine leaking out in between wees.

When weeing, the muscles of the bladder wall squeeze the urine out of the bladder and at the same time the muscles in the sphincter relax to let the urine flow down the urethra. The valves between the ureters and bladder prevent urine flowing backwards up to the kidneys.

There are lots of ways you can encourage your child to have a healthy bladder – here are some suggestions:

During the school day, your child could make sure they visit the toilet at the start and end of the school day and at every break or playtime. Children may rush going to the toilet if they are worried they will miss out on exciting playtime so encourage them to spend as long as needed. If your child seems reluctant to use the toilets at school, try to find out why and then talk to their teacher.

The nurses may advise you to encourage your child to go to the toilet at set times – every three to four hours – during the day even if they do not need to pee. Some children find a watch with an alarm a useful reminder to go to the toilet.

Getting in the right position on the toilet is important too – sitting on the toilet seat with legs wide apart resting both feet flat on the floor if they can reach. If your child cannot reach the floor, you can buy a plastic step from most chemists or childcare shops. Boys who stand up to wee should stand with their legs apart in a comfortable natural position.

We may suggest that you encourage your child to use ‘double voiding’. When your child has finished weeing, ask them to stay on the toilet and relax for 20 seconds or so before trying to wee again.

Fluids are vitally important in keeping healthy so encourage your child to drink plenty of liquid throughout the day – more if the weather is hot. It is better to drink small amounts of fluid frequently throughout the day rather than lots in one go when thirsty. Guidance from the National Institute for Health and Care Ecxellence (NICE) suggest the following amounts for children and young people.

• seven to 12 months – 600ml
• one to three years – 900ml
• four to eight years – 1200ml
• boys aged nine to 13 years – 1800ml
• girls aged nine to 13 years – 1600ml
• boys aged 14 to 18 years – 2600ml
• girls aged 14 to 18 years – 1800ml

Some drinks are better for the bladder than others – drinks containing caffeine or artificial sweeteners or fizzy drinks can irritate the bladder. Fruit squashes are a good alternative to water but only if they are diluted well, but darker coloured squashes such as blackcurrant are best avoided.

If you are not sure which drinks are irritating your child’s bladder, you could try limiting them to milk and water for a couple of weeks before introducing other drinks one at a time.

The same muscles control pooing as well as weeing so constipation can affect how your child wees. Eating a healthy diet with a wide range of fruit and vegetables is usually enough to keep your child’s bowels working properly. Drinking plenty of fluid is important as well. Some families find introducing probiotic yoghurts or drinks helps avoid constipation. They also change the bacteria in poo reducing the risk of urinary tract infection.

When your child has had a poo, teach them to wipe from front to back as this reduces the risk of germs in poo being transferred to the urethra and then into the urinary system. This is particularly important for girls as there is a shorter distance between the anus and urethra.

Straining to have a poo can weaken the muscles supporting the bladder (pelvic floor muscles). Encourage your child to eat a balanced diet and drink plenty of fluids to prevent constipation. If you are concerned about your child’s constipation, talk to your family doctor (GP) or local community pharmacist (chemist).

Health supplements such as probiotics and D-mannose can reduce the risk of developing an infection. Talk to your child’s nurse for further details.

Our skin is our best barrier against infection and the skin around the genitals is no different. Your child should wash every day, paying particular attention to this area. Water and a gentle pH balanced soap is best for keeping clean, but try to avoid using highly perfumed soaps or shower gels as these can be irritating.

Every member of the family should have their own flannel and towel to avoid germs being passed from one person to another. These should be washed frequently on a 60° wash cycle with nonbiological soap powder or liquid. Towels and flannels do not need fabric softener as this reduces their absorbency.

• Visit the toilet at set times throughout the day – about every three to four hours.
• Get into the right position to wee – stay comfortable and relaxed.
• Try not to rush. 
• Rest for 20 seconds and try to wee again.
• Drink plenty of fluids.
• Avoid fizzy drinks, ones containing caffeine or artificial sweetners or dark coloured squashes.
• Health supplements can help prevent infections.
• Eat a healthy balanced diet to avoid constipation.
• Wipe from front to back.
• Keep the area clean with your own flannel and towel.