Pediatric Continence Consultation
Continence concerns can affect far more than physical health. Functional constipation, urine and stool accidents, bedwetting, and toilet training challenges can impact a child's confidence, emotional well-being, school participation, sleep, relationships, and overall quality of life. Although these symptoms can be frustrating and stressful for children and families, they are common, treatable, and deserve compassionate, evidence-based care.
I partner with families to better understand the medical, developmental, and other factors that may be contributing to bowel and bladder symptoms. Together, we develop practical, evidence-based recommendations that fit your family’s daily life. Consultations are designed to provide the time needed for a comprehensive evaluation, thoughtful discussion, and personalized treatment plan. My goal is to help children build confidence, improve quality of life, and achieve lasting success. Most continence-related symptoms are not something children choose or can simply outgrow. With the right support, patience, and consistency, children can make meaningful progress.
Common Concerns Addressed
Functional constipation
Stool accidents/soiling (encopresis)
Bedwetting (nocturnal enuresis)
Daytime wetting (diurnal enuresis)
Urinary urgency/frequency
Toilet training challenges
Urine or stool withholding patterns
Care may include
A comprehensive evaluation to better understand your child’s history and identify the factors that may be contributing to their symptoms
Abdominal imaging (e.g., KUB, single-view X-ray), when appropriate, ordered prior to the initial consultation so we can review the results together during your child’s first visit
Medication recommendations, when appropriate, as part of a comprehensive treatment plan
Age-appropriate toileting routines and practical strategies
Collaboration with your child's primary care provider, specialists, therapists, school personnel, and other members of your child’s care team
When an Outside Referral May Be Needed
Some bladder and bowel conditions require specialty evaluation or treatment that is outside the scope of this practice. When appropriate, recommendations for referral to the appropriate specialist will be provided. Consultations are designed to complement, not replace, your child's existing primary or specialty medical care. With your permission, recommendations may be shared with your child's healthcare team to support coordinated care.
Frequently Asked Questions
What ages do you see?
Pediatric continence consultations are designed for children and adolescents ages 3–18 years.
What makes your approach different?
With more than 15 years of pediatric nursing experience, including treating children in a nurse practitioner-run Pediatric Continence Clinic at Nemours Children’s Health, I understand the impact continence concerns can have on children and families. My own experiences navigating toilet-training challenges as a parent have also given me a personal appreciation for the frustration, uncertainty, and stress families may experience. Rather than focusing on symptoms alone, I consider the medical, developmental, behavioral, and lifestyle factors that may be contributing to your child's bowel and bladder challenges. Treatment plans are individualized to your child's needs and goals while remaining grounded in current evidence-based practice.
How much does the consultation cost?
The initial Pediatric Continence Consultation is $295. Follow-up visits are $175.
Do you accept insurance?
Ezzell Integrative Health is a direct-pay practice, allowing for longer appointments, individualized care, and treatment recommendations tailored to your child's unique needs rather than insurance requirements or restrictions. Extended visits are intentionally designed to provide the time needed for comprehensive assessment, thoughtful discussion, caregiver education, and individualized recommendations. Payment is due at the time of service. A superbill can be provided for families who wish to seek possible out-of-network reimbursement from their insurance company. Reimbursement is not guaranteed.
My child has accidents. Is this just a behavioral problem?
No. Accidents are rarely behavioral in nature. Most continence concerns are medical conditions with multiple contributing factors, including bowel and bladder function, toileting habits, daily routines, and developmental readiness. Accidents are rarely within a child’s control, and a supportive, understanding approach is often the most effective.
What should I expect during the first visit?
Your initial evaluation includes a comprehensive review of your child’s medical history, growth and development, current bowel and bladder concerns, previous treatments, your goals for treatment, a focused physical exam, and review of abdominal imaging, if applicable. Together, we'll develop an individualized treatment plan tailored to your child's needs.
Why is an abdominal X-ray needed?
Depending on your child’s symptoms, an abdominal X-ray may be recommended prior to your initial consultation. An abdominal x-ray provides important information about what is happening inside your child's abdomen and allows the provider to evaluate:
The amount and distribution of stool in the colon
Evidence of significant stool retention
Rectal diameter that may affect bowel and bladder function
Patterns that may help guide treatment and monitor progress over time
The abdominal X-ray is just one piece of the overall evaluation and is interpreted together with your child's history, symptoms, and physical examination. The X-ray does not diagnose continence-related concerns on its own, but it can provide valuable information that helps individualize your child's treatment plan. If an abdominal X-ray is recommended, you will receive detailed instructions in your portal upon scheduling. The imaging center offers a cash rate of $56 or you can request the center bill your insurance directly.
Is an abdominal X-ray safe?
Yes. Imaging is a quick, low-dose X-ray that uses a small amount of radiation to create images of the abdomen. The amount of radiation is considered very low, and the diagnostic benefits generally outweigh the minimal risk. Your provider only recommends imaging when it is expected to provide helpful clinical information and serial X-rays are generally not recommended.
Do you prescribe medication?
When appropriate, recommendations may include evidence-based medications as part of a comprehensive treatment plan. We will review the available treatment options together and create an individualized plan that aligns with your child's needs, your family's goals, and what is most practical for your daily life.
Do you recommend any specific bladder or bowel program?
I frequently recommend M.O.P. (Modified O'Regan Protocol)developed by Dr. Steve Hodges, a pediatric urologist at Wake Forest. This protocol is supported by published research and is an effective treatment approach for many children. If this is an appropriate approach for your child, we will discuss the program in detail and incorporate its principles into an individualized treatment plan. Other treatment options may be recommended based on your child's individual needs, goals, and response to treatment.
How long does treatment usually take?
Progress varies for every child. Many continence conditions develop over months or years, so improvement often occurs gradually. Our goal is to make steady, sustainable progress rather than quick fixes.
Do you work with my child's pediatrician?
Yes. With your written permission, I am happy to collaborate with your child's pediatrician, specialists, therapists, school personnel, or other members of your child's healthcare team.
What if my child has seen other providers without success?
Many children have already tried medications, reward systems, or other interventions before coming to our practice. Continence concerns are often complex, and progress may require looking more broadly at contributing medical, developmental, behavioral, and lifestyle factors. This comprehensive approach can help identify barriers to improvement and guide a more individualized treatment plan.
When should my child be seen sooner?
Some symptoms require prompt medical evaluation and may not be appropriate for this practice, including:
Fever with urinary symptoms
Severe abdominal pain or vomiting
Blood in the urine or stool
New onset muscle weakness or difficulty walking
Sudden loss of bladder or bowel control
If these occur, contact your child's primary care provider or seek urgent medical care.
Will my child outgrow bedwetting?
Many children eventually become dry overnight, but persistent bedwetting is common and can affect a child's self-esteem, confidence, sleepovers, camps, and other social activities. While some children improve with time, others continue to have accidents. A comprehensive evaluation can help identify contributing factors and determine whether treatment is appropriate.
Will my child be embarrassed during the visit?
Creating a safe, supportive, and judgment-free environment is the priority. Many children feel relieved to learn they are not alone and that these concerns are common, treatable, and not within their control.