Bedwetting and Constipation in Children

Bedwetting at night (also known as ‘nocturnal enuresis’) can be distressing for children and parents, especially if they are fully toilet trained and are accustomed to sleeping through the night without any accidents. Nighttime bedwetting isn’t something children can control and is caused by a breakdown in communication between a child’s bladder and brain. A link between bedwetting and children’s constipation was first made in the mid-80s, however more recent studies have confirmed that constipation may be the source of a child’s bedwetting more frequently than previously understood.

Causes of Bedwetting in Children

There are many potential causes of bedwetting in children, and there is no “quick-fix”. It’s important to evaluate all the factors that may be contributing to the problem. Contrary to some popular beliefs, bedwetting is not caused by a child not wanting to get out of bed to use the bathroom, nor is reducing fluid intake in the evening necessarily an effective way to reduce bedwetting accidents. Causes of bedwetting can include the following:

Genetic predisposition
Abnormalities in the spinal cord
Urinary tract infections
Extremely deep sleep or difficulty waking up
Hormonal factors (insufficient antidiuretic hormone which helps to reduce how much urine is produced by the kidneys)
Speed at which the central nervous system develops

The Link Between Bedwetting and Children’s Constipation

Children may experience constipation related bedwetting even without showing the symptoms most typically found with children’s constipation. An excess of stool in the rectum can be a hidden source of a child’s bedwetting problem, although bedwetting can also be caused by several other factors. When a child’s bowel is enlarged by an excess of stool it puts pressure on the bladder, which can cause bedwetting accidents by shrinking the bladder’s capacity to hold urine. It can be difficult to communicate with your child about whether or not they are constipated, so it’s important to look for signs of constipation if your child is wetting the bed.

Symptoms of Children’s Constipation

Because the size and consistency of stool is a contributing factor to bedwetting due to constipation, it’s important to track your child’s stool. A stool chart can be a useful way to know what to look for. Is your poop normal infographic

Stools that are unusually large, hard, or compacted cause the most pressure on the bladder and could be the culprit behind a child’s bedwetting. Symptoms of constipation in children also include:

Infrequent bowel movements
Excessively large stool
A reluctance to pass stool
Complaints of stomach pain
More than two bowel movements per day without full evacuation
Extremely frequent and/or urgent urination
Stool withholding
Leakage and/or stool accidents

Bedwetting and Bowel-Bladder Dysfunction

If a child holds their urine too long during the day, it can cause bladder-bowel dysfunction which may lead to constipation and bedwetting at night. Establishing healthy bathroom habits can help alleviate constipation in kids and reduce instances of bedwetting. Steps parents can take to address bowel-bladder dysfunction include:

Encourage your child to use the restroom every 2-3 hours, even if they aren’t telling you they have to go to the bathroom. A regular bathroom routine helps to “train” the bowel and bladder to expect regular evacuation, and accustoms your child to using the bathroom regularly.
Make sure your child drinks plenty of non-diuretic fluids throughout the day. This helps moisten stool, making it easier to pass, and fills the bladder prompting more frequent bathroom use.
For younger children, provide a step stool so their legs don’t dangle while using the toilet. This positions their body properly, making bowel movements easier and may help them be less reluctant to pass stool.
Ensure your child is getting adequate daily fiber intake. The amount of daily recommended fiber varies for children depending on age, weight, and gender, so consult with a pediatrician to determine what is right for your child.
Make sure your child is participating in a daily fitness activity. Exercise helps keep the bowels moving! Playing active games like hide-and-seek, tag, fun sports or other activities that kids enjoy.

Relieving Constipation in Children

Studies have demonstrated that relieving constipation in children helps reduce bedwetting accidents. Relieving your child’s constipation is a good step to try as you determine the cause - and remedy - for your child’s bedwetting. There are many constipation medications for children, and it can be confusing to know which one is right for your child. Always consult with a pediatrician before giving any over-the-counter constipation medication to children. Constipation solutions may include: Stool Softeners Stool softeners for children can be administered orally or rectally, and are effective for mild or occasional constipation. Rectal stool softeners, like a mini-enema, act more quickly. Oral stool softeners can take 12-72 hours to be effective. The primary ingredients in stool softeners are docusate sodium and docusate calcium Hyperosmotic Laxatives Hyperosmotic laxatives work by increasing the amount of water in the intestine, moistening stool and making it easier to pass. The main ingredients in hyperosmotic laxatives are polyethylene glycol and glycerin. They are gentle, mild, and generally considered safe for use with children. Make sure your child drinks plenty of water when employing hyperosmotic laxatives, as it helps them work more effectively. Stimulant Laxatives Stimulant laxatives can be an option for fast relief from painful children’s constipation and are usually recommended for use in children ages 6 years and older. They can come with some uncomfortable side-effects and are generally not the first choice for constipation in kids. Stimulant laxatives work by stimulating the muscles in the rectum, activating them to push stool out of the body. The main ingredients in stimulant laxatives are bisacodyl and sennosides. Lubricant Laxatives Lubricant laxatives are an option for fast relief from painful constipation for children aged 6 years and older, but the uncomfortable side-effects mean they are not the first choice for children. Lubricant laxatives coat stool, making them slippery and easier to pass. The primary ingredient in lubricant laxatives is mineral oil.

Bedwetting Solutions for Children

Many children will outgrow bedwetting naturally, so it’s important to take into consideration the frequency of accidents and how distressing they are to your child before pursuing treatment. Each child’s developmental curve is different, so consult with a pediatrician when determining if your child’s bedwetting is problematic or not. There are some basic steps you can take at home to help reduce bedwetting incidents, including: Limit foods and beverages that contain caffeine. While young children typically don’t consume caffeine, there are foods that have caffeine in them such as chocolate (in liquid, solid, or dairy form), some flavored breakfast products, many sodas, and tea. Encourage regular bathroom use. This is a logical step for younger children who are still getting used to remembering to use the bathroom, but it’s also important to encourage older children to take regular bathroom breaks. Children should not wait until they feel a sense of urgency before emptying their bladder, but rather urinate approximately every 2-3 hours regardless of need. Empty the bladder before and after the bedtime routine. Urinating both before and after the bedtime routine (brushing teeth, getting into pajamas, reading a bedtime story) is known as ‘double voiding’ the bladder, and can help reduce the frequency of nighttime bedwetting. Ensure your child has a well-lit pathway to the bathroom, and remind them right before bed that it’s okay to use the bathroom at night. Use a moisture alarm: A moisture alarm is a small device (battery operated) that senses any moisture while your child sleeps and emits a noise that wakes your child and prompts them to use the bathroom. It may take some time for a moisture alarm to be fully effective, while your child becomes accustomed to it, so don’t be discouraged if this doesn’t work the first time you use it.

DocuSol® Kids Can Help!

DocuSol® Kids is a first-of-its-kind, mini enema with a non-irritating formula that functions as a stool-softening, hyperosmotic laxative by drawing water into the bowel from surrounding body tissues, replicating a normal bowel movement. This unique formulation provides children ages 2–12 fast, predictable relief of constipation within 2 – 15 minutes. DocuSol® Kids was designed for easy use at home. The DocuSol® Kids tube is designed to offer a minimally invasive, soft, and flexible tip, avoiding any scratching or irritation to the skin. Just a 5-milliliter tube delivering 100mg of docusate sodium, the medication provides fast relief in just a few, easy steps! Learn more about DocuSol® Kids on our website, including where to buy, doctor tips, family resources, and frequently asked questions. Disclaimer: The material contained is for reference purposes only. Alliance Labs, LLC and Summit Pharmaceuticals do not assume responsibility for patient care. Consult a physician prior to use. Copyright 2020 Summit Pharmaceuticals and Alliance Labs, LLC. Sources: