Bedfordshire and Luton Children's Continence Team

We help children and young people who have difficulty controlling their bladder or bowels. This is referred to as continence and includes constipation, day time wetting and night time wetting. We can help children and young people who have already had support from the health visiting and school nursing service but need further support.

Stage 1 - Before a referral to our service is made, we recommend that parents and carers use the information on peeing, pooing and toileting, the Eric website, or speak to a school nurse, health visitor or GP. They will be able to provide advice and guidance on toileting issues. 

Stage 2 - If a child or young person is still experiencing difficulties, a referral can be made to see a specialised champion advisor. Champion advisors are not available in all locations. 

Stage 3 - If a child or young person is still experiencing difficulties, and more specialist support is needed, a referral can be made to the children's continence service. 

Appointments may be by phone, video link or face to face depending on what is appropriate for you and your child to complete a full and accurate assessment. If the appointment is face to face or via video link then your child does need to attend the appointment. If your appointment is via telephone your child does not need to be there.

If your appointment is face to face, when you arrive at the clinic we will check your details. We will also ask your child or young person about how they are. During the appointment we will check your child or young person's height and weight. At the first appointment, the nurse or doctor may look at their spine. They may also need to touch and press their stomach. 

We will talk about their wee and poo difficulties with you and your child or young person. They will have the chance to speak about any worries they might have. 

We will then agree a plan of action and treatment that you and your child or young person are happy with. 

It's important your child or young person follows the advice we give. Fill in any charts you have been given and give medicine if prescribed. 

Cancelling your appointment

If you cannot attend your appointment or take the planned call then please let us know at your earliest opportunity so that this appointment can be offered to another family. 

If your child has improved and they are no longer having any issues, please let us know. We can decide if we need to proceed with appointment or think about a different plan.

Children with additional needs can learn to control their bladder and bowels. This is called continence. Some children or young people may have a significant diagnosis that will prevent them from controlling their bladder or bowels. If your child or young person has Attention Deficit Hyperactivity Disorder (ADHD), autism or dyspraxia, this should not prevent them from controlling their bladder and bowels. 

All children are entitled to a continence assessment. This assessment determines which treatment pathway your child will follow. 

Treatment pathways include:

• toilet training
• toilet training and products
• products only

Continence products such as nappies are not provided for all children. Products are not given for constipation, day or night time wetting alone.

Toilet training workshops are aimed at parents and carers. They take approximately 2 to 3 hours. Advice will be given and shared to help your child become toilet trained.

Appointments may be by phone or in clinic depending on your child's needs and the progress they are making. Read more about getting ready for your appointment.

Some children may do lots of little pees many times a day or they may have wetting accidents. A bladder scan checks that their bladder is working correctly. The scan can show how much urine a bladder can hold and if it empties fully after going to the toilet.

A bladder scan takes pictures of a bladder using ultrasound waves. Your young person or teenager will not be able to feel anything. The ultrasound pulses are sent through the skin to the body and bounce back to create an image.

Before the appointment

Your young person or teenager will be asked to come to the appointment with a full bladder. This means not having a wee. This is important because if the bladder is not full we may not be able to do the scan.

If you or your young person or teenager would like a chaperone during the scan, please request this before the appointment.

At the appointment

They will be asked to lie on a couch fully dressed. The nurse will lift up their top to see their stomach. We recommend your child wears trousers or leggings to the appointment. Some lubricating gel will be put on their stomach so that the ultrasound probe can glide gently over the tummy to find a good image of their bladder. 

Your young person or teenager will then need to go to the toilet to empty their bladder. The scan will then be repeated. 

The nurse will then tell you at the appointment how the bladder is working. They will make a care plan with you and your young person or teenager.

Different sensations can affect how a child responds to using a toilet. If your child or young person is experiencing toileting difficulties, try to talk to them about which parts of toileting they find challenging. This may include sights, sounds, smells or balance. 

For further support you can read more about:

• sensory needs and toileting
• potty training children with additional needs
• what is interoception

An alarm is a small training device. It teaches your child to stop wetting themselves at night. You can choose to purchase an alarm yourself. Read more about bedwetting alarms.

When your child is discharged from the bowel clinic, it is important that they continue the good habits they have learnt. This includes continuing:

• to take macrogol medication
• to drinking enough water-based fluids every day
• to encourage your child to let you know if they feel any signs of constipation
• to use a toilet step to fully empty the bowel
• to eat a healthy balanced diet with lots of fruit, vegetables and wholemeal carbohydrates

There are no issues with your child regularly taking macrogol medication. Only reduce or stop the medication if they have no signs of constipation at all. 

At regular intervals you can try to reduce the macrogol medication. Reducing the sachets can be a whole or half a sachet at a time. Each sachet needs to be made up with the appropriate amount of water. The amount of water needed will be stated on the medication leaflet. This can then be added to foods or drinks to disguise the taste.

If at any point your child struggles to poo or if they pass large or hard lumps of poo, increase the sachets again. It is also fine to restart taking macrogol once stopped.

Once your child has stopped taking the medication, it's a good idea to keep a small stock at home. This can be helpful in case you need to re-start or give an occasional dose.