When talking to a father yesterday about his daughter's progress with his alarm, the subject of constipation and stooling problems came up. He mentioned that she had an experience with hard, painful bowel movements a few years ago and since that time has withheld stool and had ongoing periods of stool leaking and irregular bowel movements. He wondered if this had any impact on her bedwetting.
Constipation is loosely defined as irregular, infrequent hard bowel movements. In our society, it is common for children (and adults) not to receive the daily fiber that they need to have a daily soft bowel movement. If fiber is not present in the gut, messages to empty become less frequent. While the waste stays in the gut, water is reabsorbed by the body, producing a firmer, drier stool. This type of stool is larger, and more difficult and painful to pass. When pain is associated with having a bowel movement, the tendency for children is to withhold. Ignoring the messages that do come can lead to an over distended bowel and a viscous cycle begins. Liquid stool can seep around the large hard stool, leading to a condition called encopresis. Children often do not "feel when this is happening, so leaking in the underwear occurs.
Since ignoring messages from the bowel and ignoring messages from bladder go hand in hand, it is not unusual that constipation and wetting problems occur together. The other factor that plays a role is that a distended bowel takes up more space. The bladder cannot fully expand if a large amount of stool takes up the abdominal space.
In some children, solving constipation and observing a regular soft stool makes a big difference in their ability to become dry at night. Some tips are:
Making sure that her fiber intake is adequate. A guideline for fiber requirements in children is their age plus 6. For example, a 8 year old would require at least 14 grams of fiber a day. My patients' favorite source of fiber is Cracklin' Oatbran Cereal. Read labels when buying food and opt for the higher fiber choice. Fiber bars or drinks can also be used.
Add products such as Miralax, with your health care provider's guidance, if fiber isn't adequate.
Have a regular stooling time, where she sits quietly and has uninterrupted time in the bathroom.
Provide a stool for her to put her feet on and a toilet lid insert if she feels like she will "fall in.
She can continue with the bedwetting alarm while you are working on correcting infrequent stooling patterns. You may begin to notice that the alarm goes off later in her sleep cycle or that she becomes more responsive to her alarm and her full bladder as her constipation is corrected.
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