Constipation is common in children with bedwetting and can be a major factor causing the problem. Even if a child regularly passes bowel motions it is still possible that the bowel is filled with hard, impacted faeces, and this can interfere with the normal functions of the bladder.

What causes constipation?

The most common cause of constipation is regularly holding on when a child needs to pass a bowel motion. This might be because they don’t like going to the toilet at school, may be embarrassed to go at a friend’s house, lack of opportunity, or not wanting to stop what they’re doing. Diet may play a part, with processed, low fibre diets more likely to contribute to constipation than fresh, high fibre diets. Stressful events can play a part, such as family upheaval, a new school or kindergarten, or illness. It might start after they’ve passed a hard or painful bowel movement, or if they have irritation around the anus. Inadequate fluid intake can lead to hard

bowel motions, so it is very important for children to drink water regularly through the day.

What happens to the rectum?

When the bowel motions are held for too long, the rectum reabsorbs the water from them and they become harder and more difficult to pass, which can make a child more reluctant to pass a bowel motion the next time. The hard faeces build up and the rectum is stretched, with a loss of sensation so the child finds it harder to know when they need to pass a motion. Sometimes a child can pass regular bowel motions but hard faeces are still in the rectum and the rectum is still stretched.

What does constipation have to do with bedwetting?

When a child is constipated with a stretched rectum, it can press on the bladder and interfere with the amount of urine it can hold. It can also irritate the bladder, causing it to spasm or empty when it shouldn’t. In some cases, when the constipation is treated and normal bowel function is re-established, bedwetting and other symptoms may resolve without the need for other treatment.

What can you do to help?

The aim is for your child to establish regular bowel motions, which are soft and easy to pass. The child should have 4 or more bowel motions per week.

• Bowel activity occurs about 20 minutes after each meal. The child should sit on the toilet and try for a bowel motion at that time. One of the most important times is after breakfast.
• The feet should be well supported with a stool.
• The child should try to relax the pelvic floor muscles.
• The child should sit and try for a few minutes but no more than 5 minutes.
• Always ensure the child wipes his/her bottom properly.
• Tell the child to never ignore the messages the bowel is sending to their brain, if they are able to go to a toilet. When they need to go, they should go or they risk becoming constipated.
• Medications: Your doctor or nurse will tell you if the child needs to take any medications to help with their bowel motions. The medications will make their bowel motions soft, more frequent and easier to pass. Make sure the child takes them as directed.
• The child should drink at least 5 or 6 glasses of fluid per day (water is the best option). Your health professional will inform you of the minimum amount, about 50 mL per kg per day.
• The child should eat fibre in their diet. A variety of fruit, vegetables and cereals such as porridge are good options. A child should aim for 2-3 serves of fruit and 4-5 serves of vegetables daily.