If your child has attention-deficit/hyperactivity disorder (ADHD) and also struggles with bladder control or toileting issues, you are not alone. Many parents are surprised to learn that these challenges often go hand-in-hand.

The good news? There are clear reasons behind the connection. Even better, there are practical steps you can take to help your child feel more confident and in control.

ADHD can cause challenges with bladder control for a few reasons. ADHD is a condition where the frontal lobe of the brain has a processing issue. This can affect the brain's ability to interpret signals from the bladder when it is full. Meanwhile, impulse control and distractions can delay a child from developing healthy urination habits.

Children with ADHD can also have co-existing conditions that can affect their peeing such as constipation, sleep issues, oppositional defiant or conduct disorder and anxiety disorders. Voiding dysfunction (challenges with bladder control) and enuresis (bedwetting) can take a longer time to improve in children with ADHD because of these reasons.

Some medicines used to treat ADHD can affect urination as well. Amphetamine stimulants can sometimes make it harder for a child to relax their muscles to pee. Methylphenidate stimulants have been shown in animal studies to change pressures in the bladder and increase the bladder's ability to hold urine.

This does not mean that your child should stop taking their medicine. But it is a good idea to discuss this with your pediatrician if you are noticing changes in urination habits after your child starts or changes medicine. Pay particular attention to this when changes to the dose of medicine are made.

Mainstays of treating enuresis and voiding dysfunction include peeing on a regular basis, managing fluid intake and addressing constipation. Some children also benefit from pelvic floor physical therapy to learn how to relax certain muscles when using the bathroom. If behavioral changes do not help, medicines can be started if needed.

Children with ADHD can benefit from a combination of the above behavioral changes with behavioral therapy recommended for ADHD. The following are some helpful tips for families:

Establishing a regular routine can help strike a balance with distractions. Sometimes it can be hard to pull your child away from an activity that grabs their attention so they can use the bathroom. It can help to have them learn to urinate as a routine before certain activities, such as before they get in the car to go to school, during recess or before a fun activity or play date.

Setting small, reachable goals based on using the restroom every 2-3 hours during the day and right before bed at night can help as well. You can set a plan for these before certain activities in their daily routine. It is important to focus on building these habits instead of on the accidents that can happen.

Avoid punishments when accidents do happen. Children with voiding dysfunction and enuresis oftentimes already feel bad about this issue. Punishments can increase a child's struggle and make children feel worse about themselves.

Keep teachers in the loop about allowing access to school bathrooms and prompting your child to use the bathroom before starting engaging classroom activities. Parents and caregivers can ask your child's pediatrician, urologist or nephrologist for a letter to allow them regular access to water and bathroom breaks.

Bathroom accidents and bedwetting can be a tricky experience for any child and their caregivers. In children with ADHD, it is important to find routines that work for your child. This includes routines for going to the bathroom. It is also important to talk to your doctor if you notice your child is having struggles with accidents, wetting the bed or constipation.

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Julie Cheng, MD, MAE, FAAP, is an assistant professor of urology at the University of Washington and Seattle Children’s Hospital in Seattle, WA. She is a member of the American Academy of Pediatrics Section on Urology. She is currently the co-chair of the Education Committee for the Section on Urology

Kathleen Kieran, MD, MSc, MME, FAAP, is a professor of urology at the University of Washington and Seattle Children's Hospital in Seattle, WA. She is a member of the American Academy of Pediatrics Section on Urology. She is a member of the Section on Urology's Executive Committee.

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