Early Toilet Training Tied to Increased Risk of Developing Daytime Wetting Problems

A team of researchers has found that children who are given early toilet training are at a three-fold increased risk of developing daytime wetting problems later.

Potty training is a key milestone that almost all children learn. Researchers at Wake Forest Baptist Medical Center found that children who begin toilet training before the age of 2 years face a higher risk of developing daytime wetting problems later.

The researchers based their finding on the study conducted on 112 children aged between 3 and 10 years. Half of them visited the urology department for daytime wetting or urinary urgency/frequency. They were later compared to a group seen in a general pediatric clinic and pediatric emergency room with no history of dysfunctional voiding.

"Parents who train their children early to meet preschool deadlines, to save landfills from diapers or because they think toddlers are easier to train should know there can be serious repercussions," said lead author Steve Hodges, M.D., an associate professor of pediatric urology at Wake Forest Baptist.

The researchers used questionnaire to gather detail on the age toilet training was initiated and the presence of daytime voiding dysfunction.

They grouped the patients in three different categories of potty training: early training (before the age of 2), normal training (between 2 and 3 years) and late training (after the age 3).  There were a total of 38 early, 64 normal and 10 late trainers.

The researchers noticed that 60 percent of those with early training had daytime wetting and a 3.37 times increased risk of daytime wetness as compared to the normal group. The researchers strongly believed that with early training, children get more prone to voiding dysfunction as they are more apt to holding their stools or urine. With early training, children were three times more likely to complain of constipation than normal trainers.

"When children hold stool, it backs up in the rectum," Hodges explained. "The enlarged rectum presses against the bladder, reducing its capacity and causing the nerves feeding the bladder to go haywire. Almost all of the children who had wetting also had constipation."

Apart from this, younger children are more apt to delay peeing; this behavior triggers bladder contractions and reduced bladder capacity. It has also been documented that bladder growth continues till children reach the point of toilet training.

Among 10 children who were given toilet training after age 3, seven of them suffered from daytime wetting problems and constipation problems.

"This does not mean late potty training causes dysfunctional voiding," Hodges explained. "It means that when kids train late, it's very likely because they are already constipated, which makes toilet training extremely difficult. Parents whose 3- or 4-year-olds have trouble training are often blamed for 'waiting too long,' but our data suggest waiting isn't the problem - instead it's likely constipation."

The study is reported online in Research and Reports in Urology.