Dr Phil Kieran: I'm worried my child goes to the toilet too often 

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My son is four years old and needs to wee almost every hour. He has a good appetite and is very active, which might explain why he needs to go to the toilet so often. I’m worried it might be a problem when he starts school in September. What would you suggest?

The first thing I tell parents concerned about toileting issues is that they almost always settle down. What constitutes a normal urinary or bowel habit varies greatly from child to child but usually doesn’t cause problems when they start school.

Depending on when your son was toilet trained, he may still be coming to terms with the sensation of a full bladder and knowing how long he can hold his urine. Very active children often take any opportunity to empty their bladder and will pee between every activity.

The same pattern is unlikely to be repeated at school as the children spend most of their time in their classroom.

If he can hold his urine for more than an hour on car journeys or when he is otherwise distracted, you likely won’t have any issues.

If he wants to use the toilet in shorter periods, I would look at how much he drinks. Most children are reluctant to drink water, so we encourage them to drink continuously.

This is good advice for the majority, but for some, it causes them to consume too much water, causing them to pee frequently.

If he sleeps through the night and is dry in the morning, you have nothing to worry about. Even if he’s not dry, bed wetting is still very common at this age, so there’s no need to fret.

If none of the above scenarios apply, it may be time to chat with your GP.

I would check for inflammation in the penis which can cause an increased sensation of needing to pee. I would also test for a urinary infection, although these are extremely rare in boys once they are out of nappies.

Some children struggle with night-time continence well past school starting age, and occasionally doctors use medication to help them stay dry at night if they are away from home, such as staying overnight with a friend.

The next thing to consider is bowel habits. If your child is constipated (or not clearing his bowel completely), the full rectum will compress the bladder, reducing its capacity. Children need to pass one to two soft bowel motions every day. Increasing fibre (fruit and veg) intake can help this a lot.

Your son’s urinary frequency will likely resolve before school or with minor adjustments.

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