Bed Wetting / Constipation

Bed Wetting

Bedwetting, also known as enuresis, is a condition whereby children wet the bed. It is fairly common in children and is only considered abnormal if it happens consistently over the age of 5. There are many reasons why children may wet the bed, but laziness is not one of them. It is important as a parent to be open-minded when it comes to this condition.

The only and major symptom of bed-wetting is bedwetting. 

Causes of bed-wetting:

  • Genetics
  • Deep sleep is the major cause of bedwetting
  • Stress
  • Weak bladder due to an under-developed central nervous system
  • Hormonal factors
  • Urinary tract infections
  • Abnormalities in the spinal cord
  • A small bladder

The reason why the age of 5 is the cut-off is because this is believed to be the age when bladder control is achieved. Call our doctor if:

  • Your child is older than 5 and wets the bed more than twice a week
  • Your child is older than 5 and wets the bed either during the day or at night

Diagnosis of bed wetting is made through a thorough history. The doctor will first rule out whether or not your child has an underlying condition that is causing the bed-wetting. They may then do a physical exam followed by a urine exam to rule out diabetes. A physiological exam will then rule out emotional stress of any other psychological problems. In most cases however, there is no cause found for the bed-wetting. 

When should you worry about bedwetting?

  • If a child who was not previously bedwetting begins to wet the bed again.
  • If there is associated pain, blood stains and a burning sensation when passing urine.
  • If there is increased frequency and an urgency of passing urine.

The above symptoms point to a urinary tract infection and may need further investigation. It may also be diabetes or an abnormal urinary tract.

If a child who was previously okay begins bedwetting, they may be undergoing a mental problem at school or at home that may need to be addressed.

Treatment

  • Avoid caffeinated drinks or soft drinks in the evening.
  • Ensure your child goes to bed before sleeping.
  • Use an alarm which rings when the bed gets wet (bed alarm), this ensures that your child learns to wake up when the bladder is full.
  • Rewards after a successful dry night go a long way.

Medication for Bed Wetting

Most children who wet the bed do not need any medication. Sometimes however our doctor may recommend medication after a careful analysis of the child’s individual condition.

The most common drug given is known as DDAVP, it works by reducing the amount of urine your child produces at night. It is reserved for children who fail to show improvement even after the use of the alarm system. It may also be used by children who are attending school camps and sleep overs.

DDAVP is safe to use as long as you never exceed the recommended dose. It is also ideal that you limit the amount of fluid intake. It has a good response rate and children may experience a dry night after the first try. 

Call us for an appointment with our Paediatricians at Kids Health Space.

Constipation

This refers to the inability to pass stool or passing of minimal very hard stool accompanied by pain. There are many causes of constipation because it is by far one of the most common childhood conditions. About 30-40% of children each year suffer from constipation and therefore as a parent, it should not be a cause of worry. 

Symptoms of constipation:

  • 2 or less bowel movements in a week.
  • Passing of hard stool or sometimes pellet-like.
  • Inability to pass stool.
  • Pain when passing stool with or without associated fresh bleeding or tear.
  • Avoidance of bowel movements.

Causes of constipation:

  • Dehydration or not taking enough water.
  • Pain when passing stool.
  • Forgetting to pass stool.
  • Certain medications have been associated with constipation.
  • Anal deformities such as an imperforate anus or Hirsprungs disease or spinal pathology.
  • Coeliac disease, inflammatory bowel diseases, hypothyroidism, hypercalcemia etc.
  • Taking of constipating foods or lack of fibre in the diet.

Imitators of Constipation:

Breastfed and over a year old – This is because their body is adapting to eating solid foods and they may take some time to find routine.

Straining babies – In young babies, straining is normal as they are simply trying to push stool against gravity. Redness of the face while pushing stool is normal. Brief straining may occur at any age

Large stools – Keep in mind that children who eat a lot are also more likely to pass more stool and this is absolutely normal. 

Treatment of constipation:

  • Give your child adequate water.
  • Encourage toilet time through a reward system with every successful stool passage.
  • Make toilet time interesting.
  • For children who are too busy, make toilet time a part of their schedule.
  • Encourage them to sit on the toilet and support them for stool passage.
  • Add prune juice to their diet. It contains sorbitol which adds bulk to stool.
  • High fibre diet like vegetables, fruits etc.
  • Laxatives as advised by medical practitioners.
  • Fix the underlying medical conditions like anal fissures, hypothyroidism etc.

Medical treatments:

An enema may be used to encourage bowel movement

The child may also be put on a laxative although for a short period until the constipation passes.

Laxative options for children
  • Lactulose - The most common laxative in the market. The formulation is a syrup and is sweet tasting. May be mixed with juice or milk. It works by softening the stool and may cause smelly farts.
  • Movicol
  • Osmoloax
  • Coloxyl drops
  • Suppositories and enemas

These are tablets or liquid that are placed in your child’s bowel that cause the rectum to empty. Never give an enema to your child unless the doctor tells you to.

Call us for any concerns regarding constipation and book an appointment with our Paediatricians or Paediatric Gastroenterologist (Dr Thacker) at Kids Health Space.