QUESTION: I’m at my wit’s end about my son who has just turned nine and wets his bed. We have tried everything and are now using a bed-wetting alarm, which my child sleeps through. When we are woken by the alarm and take him out of the bed he has no memory of it,even though we have full conversations with him and he seems to be awake. I feel for my child as he is so disappointed when he wakes up wet.
QUESTION: My eight-year-old son is still wetting his bed. He has been to the GP and was prescribed medication, but we have had one dry night out of 30. Is there anything that you could recommend? It is now affecting him with sleepovers, as he needs to wear a pull-up and that can be soaked in the morning. In addition, he sleeps in a top bunk; should we move him to a different bed, as he’s a very deep sleeper?’
ANSWER: In recent times I have received a number of questions about bedwetting in older children such as the two above. Though bedwetting can be developmentally normal in young children up to the age of four, for a significant number of children the problem extends into later childhood.
At this point it can become a distressing and embarrassing problem as the child is usually acutely aware of the social implications and it can cause them to avoid important social events such as sleepovers or overnight trips.
In the long term, the emotional impact of bedwetting can affect their confidence and self-esteem. However, the good news is that with proper treatment, bedwetting is entirely fixable.
Dr Steve Hodges, a paediatric urologist in North Carolina, and an expert in the area, believes the number one cause of bedwetting in children over the age of four is constipation, although this is frequently undiagnosed and not treated correctly.
As Hodges states, “The root cause of all these problems is almost always undiagnosed constipation. So many children are told their problems are ‘all in their head’ when, in reality, the problem is physiological. Parents wait and wait for their children to ‘outgrow’ the problems – and then the kids are still wetting the bed at 10 or 15 years of age.”
How does constipation cause bedwetting?
When a child chronically withholds poo, over time a large, hard lump of stool develops in the rectum. This lump stretches the rectum to the point that it presses against and irritates the bladder.
Because the bladder is squashed, it cannot hold enough urine overnight and thus the child is more likely to wet the bed at night. When the rectum is cleared, it will gradually shrink back to its normal size and stop bothering the bladder.
The link between constipation and bedwetting was discovered relatively recently. In the 1980s, Dr Sean O’Regan, a paediatric nephrologist of Irish origin, conducted an original study in Canada in which he found that 25 children he tracked with enuresis (bedwetting) all had chronic constipation.
Of the 17 children in the study who followed his treatment for constipation using enemas, all showed dramatic reduction in bedwetting. Nine months later, 14 of the 17 (82 per cent) were still entirely accident-free. The other three had gone from having daily accidents before the therapy to wetting once a week. O’Regan went on to conduct similar studies on many more children and saw the same excellent results.
How to tell if your child is constipated
One of the reasons that many children are not correctly diagnosed as constipated is the fact that they may not have obvious symptoms to indicate it. For example, they may not complain of stomach pains and may continue to have even a daily bowel movement, but they can still have clogged-up colons.
As Hodges states, “Most constipated children pass bowel movements daily, but they do not evacuate completely.” Hodges and his colleague Suzanne Schlosberg have set up a website, bedwettingandaccidents.com, for parents. It includes a number of charts such as “12 Signs Your Child is Constipated” to help concerned parents.
Dealing with constipation
As I have written in previous columns, chronic constipation is unfortunately a common problem for young children that can have lots of consequences such as discomfort, pain and soiling accidents, as well as bedwetting.
There are many causes for constipation such as poor diet (too many processed foods make stools hard and painful to pass) and inadequate toilet training practices – in particular, children being toilet trained too early, causing them to “hold on” or avoid using the toilet ).
The treatment of the resultant chronic constipation takes time and usually requires the extensive use of laxatives or enemas – both to help clear out the colon in the first phase and to help children regulate bowel movements in the second. (In Hodges’s experience, enemas are far superior to laxatives, though these are less favoured by doctors in the UK and Ireland; see his guide on his website.)
A period of positive retraining for the child whereby they learn to stop “holding” once they feel the urge and to fully empty their bowels once they go, lifestyle changes that include more fresh fruit and vegetables and more fibre in the diet, as well as increased exercise, will help.
It is of course impossible to make a proper diagnosis from a small amount of information in the two short questions. For this reason, the first step to make progress for both these children is to get a good medical assessment to confirm or rule out constipation and then to design a treatment plan accordingly.
Constipation: a Commonly Unrecognized Cause of Enuresis, Sean O’Regan, MD; Salam Yazbeck, MD; Brigitte Hamberger; Erik Schick, MD, Am J Dis Child. 1986;140(3):260-261.
It’s No Accident: Breakthrough Solutions to Your Child’s Wetting, Constipation, UTIs, and Other Potty Problems. Steve J Hodges and Suzanne Schlosberg (2012)
For practical information and a series of helpful downloads and charts for parents on tackling bedwetting, see bedwettingandaccidents.com. See also the UK childhood continence charity Eric, eric.org.uk, which has a helpline for parents.
Dr. John Sharry, Irish Times Newspaper, July 2015. John writes in The Irish Times Health+Family every Tuesday.