Children today are becoming toilet-trained at much older ages than previous generations, and this may be a contributing factor in the increased rates of urinary dysfunction or incontinence, according to a new study.

Researchers from Belgium conducted a study in which a questionnaire was developed and completed by 321 people who had toilet-trained 812 children. The population was divided into three groups according to the age of those who trained the children.

Researchers discovered that:

• There has been a major change in toilet training in the last 60 years, with the age at which toilet training begins has been significantly postponed.

• One reason for starting training, i.e. bladder control during the afternoon nap (which can probably be considered as an indication of sufficient bladder capacity) has become less important.

• Season (summer) and starting school have become more important factors.

• Training by bladder drill (prompting the child), formerly widely used, was progressively abandoned and a more liberal attitude adopted by parents.

Some interesting findings were the % of children trained by 18 months:

• 40 to 50 years ago - 71% daytime trained, 61% nighttime trained

• Today - 17% daytime, 8% nighttime

The researchers conclude that "To start bladder training when the child stays dry during the afternoon nap and using bladder drill might help to avoid permanent bladder dysfunction. The lack of formal bladder training may be responsible for an increase in lower urinary tract dysfunction."

British Journal of Urology International August, 2000; 86: 248-252.