TableĀ 1

Causes of delayed toilet training and common features in the history

Possible diagnosisCommon features in the history
Normal variant delayed toilet trainingWell child
Achieving all other milestones
Extrinsic deadline for achieving continence, for example, starting nursery
Functional constipationHard stools
Painful to pass stools
Generalised abdominal pain
Anal fissuresVery painful to pass stools
Fresh blood on wiping
Urinary tract infectionDysuria
Urinary frequency
Fever
Detrusor instabilityUrinary frequency
Urinary urgency
Neuroblastoma or other abdominal massesConstipation
Infrequent urination
Lower limb numbness or weakness
Constitutional symptoms, for example, tiredness, weight loss
Child maltreatment, for example, sexual abusePreviously achieved continence
Vaginal discharge
Inappropriate reference to genitals
Congenital spinal malformations, for example, spina bifida occultaLower limb numbness or weakness
Recurrent urinary tract infections
Acquired neurological problems, for example, discitis, tuberculosis of the spine, external cord compression, demyelinating diseasesRefusal to walk
Back pain
Diabetes mellitusPolyuria
Polydipsia
Weight loss