Bathroom question

[sww817]

I had forgotten what a wealth of knowledge this board is! So I have another question from your experience. You know how they say urinary frequency is a PANDAS sign... is this frequency with actual output? Or is more of an OCD symptom with going frequently but not really having a full bladder? I know when we are in full crisis mode we will often see a nightime acccident or two (or naptime when he still took naps). But I am unclear about it in general. My ds went to the bathroom four times this morning before school but he actually needed to go. His symptoms had quieted down I thought, so I am curious. There is definitely plenty he could have been exposed to but I am hoping this is just a fluke.

[Mary M]

For my dd, the increased urinary output is volume.

Mary

from Michigan

[MomWithOCDSon]

I had forgotten what a wealth of knowledge this board is! So I have another question from your experience. You know how they say urinary frequency is a PANDAS sign... is this frequency with actual output? Or is more of an OCD symptom with going frequently but not really having a full bladder? I know when we are in full crisis mode we will often see a nightime acccident or two (or naptime when he still took naps). But I am unclear about it in general. My ds went to the bathroom four times this morning before school but he actually needed to go. His symptoms had quieted down I thought, so I am curious. There is definitely plenty he could have been exposed to but I am hoping this is just a fluke.

 

Similar to your food question, unfortunately, I don't think the answer is black and white. I think it can be both. I think there can be an increasingly full bladder, and OCD can also get involved and drive the child to "feel" as though he needs to go more frequently. When they're wetting the bed for the first time in months or years, it would seem that's clearly a "volume" thing, but we've experienced frequency based upon compulsion in our DS, so I know that can be just as "real" to the child.

 

My DS also tends to drink more when he's ramped up/more anxious; he'll suck down an entire sport bottle of water in under an hour. So it all seems to be part of a cycle, really.

 

Bathroom issues are very common for kids in terms of OCD behaviors, and probably having "accidents" increases the fears of being embarrassed by having to go at inopportune times or wetting one's clothes accidentally during the day while fully awake, and one thing feeds upon the other. "Better safe than sorry," their brains are telling them! Also, some kids who are feeling anxious will use a trip to the bathroom as a "transition" behavior, as in going before they begin a new activity, or walk out the door, etc.

 

When my son was first diagnosed with OCD at age 6, he practically wanted to live in the bathroom! We were on an outing, and a friend of mine was in town and came along with DH, DS and me. I told her in advance about DS and warned her that he would frequently ask . . . and then ultimately beg . . . to go to the bathroom, and not to be surprised when DS and I would tell him "No," maybe even over and over again. Which we did, because we knew it was OCD rather than genuine physical need. She laughed later and told me she was glad I'd warned her because otherwise, she would've thought we were the meanest, craziest parents on the planet!

 

But DS survived, he didn't wet his pants, and he learned that this "brain trick" didn't have to be obeyed every time. Over time, and as his health improved, he learned to distinguish genuine physical need from compulsion, but it's not easy, especially for a younger kid.

[dcmom]

We have had major bathroom issues- being the primary issue for my younger dd.

 

This is how I look at it.

 

Apparently, there is some bladder (internal) control that takes place in the basal ganglia (ggrrr). This is according to my neuro, who spoke with another specialist. If that control isn't working properly- your child's signals can get mixed up. They can empty their bladder and still have the urge to go.

 

That is the first component.

 

Then, I think ocd can latch onto this.

 

For my older daughter, while in episode, she uses the bathroom very frequently. She says it is annoying, because she will go, and still feel the urge to need to go- so in the matter of getting ready for bed, she will go 4 times. Urine will come out each time- but not a ton. I think in a normal person, the bladder fills and doesn't give you a signal until almost full- they may be constantly getting that signal- and while there may be urine each time, it wasn't physically necessary to go. For my older daughter it can be annoying- but it has not turned to ocd. (and she is not having the issue currently).

 

This was a MAJOR issue for younger daughter during first episode. I think she had the bladder signaling issue. This caused her to use the bathroom a lot. She constantly felt the need to go, and then ocd latched on and made her worry that she went a little in her panties. She had to constantly run back to the bathroom to check, and wipe A LOT. So while there was an initial physical cause, the ocd took it to an out of control point. She also did have some nighttime and a few daytime accidents at age 5 (which she hadn't done in 3 years prior). My thought on this, was that she had started to avoid going to the bathroom at all cost - because she would then be stuck in ocd compulsions for about an hour. Avoiding, led to accidents.

 

It has been helpful for me to (hopefully) see things more clearly by having two daughters go through pandas, yet at different ages, and with slightly different issues. In the end- this should be treated as any ocd is treated: ERP. We have been somewhat successful with this, although we haven't gone far enough with the exposures to see a complete resolution YET (she is down to this issue bothering her for less than 15 minutes per day, and some days not at all.)

 

I think, with pandas and ocd, it is important to look at things rationally, and say "what would most people do?" So, is it possible your son drank a lot and really had to go 4 times? Maybe. If I drink a lot, in the span of an hour, I still don't think I would go 4 times. But- this might happen once. If it happens more than once- I would say there is something going on. It may just be a interior bladder control signal issue. If it is distressing to him, he spends a lot of time in the bathroom, he tries to avoid activities, he avoids drinking or avoids using the bathroom- I think those could be an indicator there could be ocd involved.

[Dedee]

Both of my son's experienced an urge to go to the bathroom more frequently but not an increase in output. The way they described it was similiar to bladder spasms. Feeling the urge but then they go and very little urine comes out. When I spoke to Dr. M about it she explained it similiar to dcmom. Something to do with the strep antibiodies affecting the nerves giving signal to the bladder. It's been a while but there was a physiologic reason for PANDAS kids. It passed with the exacerbations. Dr. M said it was common to see it in the history of PANDAS kids. Maybe not in every exacerbation but in some. She said it actually helps with diagnosis when you see this as part of the childs symptoms. So hopefully it will pass soon.

 

Dedee

[thenmama]

xx

Edited March 27, 2013 by thenmama