Constipation and Bedwetting

By Jeffrey Lazarus, MD, FAAP

Understanding the connection and the cure

Bedwetting (or its clinical term, Nocturnal Enuresis) is not uncommon among young children who are still potty-training. And when children older than six continue to have regular nighttime accidents, it may be time to look more closely at possible underlying causes.

A major contributing factor – and sometimes the sole cause – to bedwetting is constipation. The mechanics are actually fairly simple: non-voided stools in the rectum press against the bladder, decreasing its ability to hold urine; hence, involuntary urination and bedwetting.

However, it has proven to be an often-overlooked or difficult-to-discover cause of bedwetting. An article by Steve Hodges, MD, and Suzanne Schlossberg, on tells of the story of a preschooler, Zoe, who was suspended from school due to “excessive” accidents. Visits with her pediatrician and even a urologist failed to find any physical cause.

“Turns out, everyone involved in Zoe’s case had it wrong. Zoe was fully potty trained, but she had no chance of staying dry because her entire colon was stuffed with poop, including a mass in her rectum the size of a Nerf basketball. This mass, visible in an X-ray I requested, was pressing against Zoe’s bladder and had caused the nerves feeding her bladder to go haywire. Constipation wasn’t ‘contributing’ to Zoe’s urinary symptoms; it was the main cause.”

Anecdotal and clinical evidence support these findings, yet constipation still evades many medical eyes when examining a child for bedwetting. The Slate article states, “O’Regan’s research tells you why constipation is so easily missed. Often, the rectum simply expands to compensate, like a squirrel’s cheeks or a snake’s belly. So much poop builds up that even though the child may still poop regularly, she never completely empties. Many severely clogged kids poop two or three times a day. Parents and doctors are fooled into thinking all is well.”

A 2013 report in The Journal of Urology* states that constipation likely affects 0.7% to 29.6% of children with lower urinary tract problems. For so many of these children – and their families – correctly identifying their conditions in order to properly treat them is not only a physical issue, but also an emotional and psychological one.

This study emphasizes education and demystification as essential parts of treatment, in addition to the physical protocol. “Information concerning prevalence aims to remove blame, as many children are often teased before medical attention is sought. It is important to describe the coexistence of bowel and bladder problems in children, especially because questions regarding bowel habits are frequently not expected when the child is referred for urinary tract symptoms.”

*Combs AJ, Van Batavia JP, Chan J, Glassberg KI. Dysfunctional elimination syndromes–how closely linked are constipation and encopresis with specific lower urinary tract conditions? J Urol. 2013 Sep;190(3):1015-20. doi: 10.1016/j.juro.2013.03.111. Epub 2013 Mar 29. PMID: 23545098.

Dr. Lazarus provides supplemental treatment for chronic bedwetting via medical hypnosis, and has successfully treated countless children in the last 24 years. Dr. Lazarus developed Keeping the Bed Dry,® the bedwetting treatment program based on the techniques he uses in his office.