Toilet training part-1

 To create awareness and acceptance and to educate parents regarding the chaos that a child with Autism have difficulty with in their day to day life we from 'Dhara clinic' along with our clinical partner 'Freesia occupational therapy center' had organized a workshop for parents on 'Toilet training' in the month of April'19. As learning does not stop with few and it needs to reach all the parents we are summarizing the workshop in this blog.

                    Dr. Karthik Rao, Mch – Urology, DNB – Urology/Genito – Urinary Surgery, MBBS, 

Having completed his MS- General surgery from Father Muller Medical college , Mangalore where he topped his batch , he went on to complete his Mch urology from Govt Kilpauk Medical college which is one of the three premier government medical colleges in Chennai.

 He spoke about  the 'Mechanisms of bladder and bowel control'. His presentation included the following information:

                     Toilet training is teaching your child to recognize his or her body signals for urinating or having a bowel movement and using a potty chair or toilet correctly and at the appropriate times. There is no right age to start toilet training a child. Below 12 months there's no bladder control. Between 12-18 months children develop very little control. Most children achieve continence by 24-30 months. Storage and periodic elimination of urine depend on the coordinated activity of smooth and striated muscles. Neural circuits that are involved in bladder control have switch-like or phasic patterns of activity.

Voiding is the term for passing of urine. Bladder functional development proceeds in fairly well defined stages. The newborn voids about 20 times a day. As he becomes older, the frequency comes down to 11 times at two years of age. At three years of age the striated urethral sphincter comes under voluntary control.

 

Signs that indicate when child is ready to be toilet trained,

- Asks to have the diaper changed or tells you a bowel movement or urine is coming

- Shows discomfort when the diaper is wet or dirty

- Enjoys copying what parents or older children do

- Follows you into the bathroom to see how the toilet is used

- Wants to do things (like going to the potty) to make parents happy or to get praise

- Has dry diapers for at least 2 hours during the day or is dry after naps or overnight.

Bowel and Bladder dysfunction:

          Bowel function and bladder function are interrelated. Bladder and bowel dysfunction (BBD) is a term used to describe combined bladder and bowel problems.

          During assessment the physician takes information regarding urinary history, bowel history, dietary intake, neurological or developmental delays, social stress etc and if required refer for Urine analysis, Ultrasonography of the abdomen and pelvis, Voiding cystourethrogram, Urodynamic evaluation with EMG.

          Following table explains different strategies for toilet training:

Strategies for management of constipation:

 Published by: Ms. Sai Harika Boppana,

                        Founder/Director 

                        Consultant Speech Pathologist,

                        Dhara Speech Therapy Clinic, Hosur

Dated: 02/10/19