Nocturnal enuresis, otherwise known as bedwetting, is common among young children. Even children who are completely daytime toilet trained may continue to wet the bed for many years. Pediatricians consider bed wetting a separate issue from daytime toileting.
Wetting the bed is not the child’s fault—children should never be punished for wetting the bed. It’s out of their control.
There are many possible reasons a child may wet the bed, including often-overlooked and undiagnosed constipation. Constipation can cause bedwetting because the rectum lays in close proximity to the bladder, the organ that holds urine. When the rectum is full of hard, dry stool, it can place pressure on the bladder. This can cause the bladder to become irritated, fill or empty incompletely, and contract out of control.
In many cases, treating constipation improves the bedwetting.
This type of constipation develops slowly over time, making it easy to miss in the doctor’s office. According to Dr. Steve Hodges, a pediatric urologist at Wake Forest University and the author of 7 Crazy Important Rules for Potty Training Success, children who were toilet trained very early or those who were unable to be trained until very late are at particular risk. A child can be constipated even when they have a daily bowel movement.
Pediatricians ask about hard or infrequent stool as a marker for constipation, but the key issue is really whether or not the rectum has become enlarged over time thanks to hard, dry stools. To fully understand if the rectum has enlarged, a physician may want to obtain an x-ray to visualize stool in the rectum.
Once constipation is diagnosed, it often takes months of treatment for the rectum to return to its normal size, thereby taking pressure off the bladder. Doctors will use a combination of medications to eliminate any hard, dry masses of stool in the rectum and encourage daily soft stools. A healthy diet, with ample water, fresh veggies, and fruit, will also help.
The child should also be encouraged to use the toilet often, and any barriers to safe, comfortable use of a bathroom at home or school should be eliminated. This is often difficult, as children are understandably hesitant to use the toilets at school, daycare, or other public settings. Responding to their toileting needs with patience and ample time is key.
- Bedwetting is common and not related to daytime potty use.
- Constipation is an under-recognized cause of bedwetting.
- A child can be constipated even if they have regular bowel movements.
- Treating constipation can sometimes stop bedwetting.