Constipation, Accidents and Bedwetting

Expert Q&A

Q. I am at my wits end about my daughter, who is 8 years old. About 2 1/2 yrs ago, she developed reoccurring UTIs. This led to bedwetting and daytime wetting. She doesn't have reflux,and has had DMSA scans done and Ultrasounds. She suffers from constipation, maybe from the antibiotics, as her diet is good, bloating, tenderness and soiling. We've tried various bedwetting devices that work for a few weeks then she gets another infection and all her hard work goes out the window. She is depressed and angry, embarrassed at school, and scared of being away from home.

Could the accidents and bedwetting be caused by constipation? All I get told is that there is no medical reason that she is getting these UTI's and she'll just grow out of it. She's constipated, but there must be a trigger to all these problems. Her emotional well being is suffering, she's falling behind at school from days off and I'm stressed out from lack of answers. Kim, Australia

A. Are you being treated by a Pediatric Urologist? If not, you might get a second opinion from a Pediatric Urologist to see what else can be done. If you already are, a return visit or a second opinion from a different one might be helpful, since things are working right now.

Constipation is a well known cause of urinary problems in children, and that may be the 'trigger' for all of her problems. If this is her major problem, then a Pediatric Gastroenterologist might be helpful. If in addition to her wetting accidents, she is having soiling accidents from bowel movements, then she likely also has encopresis, a complication of constipation. Again, a Pediatric Gastroenterologist should be able to help with this. Among the things that you might discuss with your doctors are:

• dietary changes, including a diet high in fiber, low in fat, and with lots of fluids, to help treat and prevent constipation (even with a 'good' diet, some kids get constipated)
• a voiding schedule, in which she tries to urinate every few hours
• a schedule for BMs, in which she tries to have a BM a few times a day, especially after meals
• use of a low dose antibiotic to help prevent further urinary tract infections
• medications to help control her wetting accidents, such as DDAVP, to prevent bedwetting, and Ditropan or Detrol, to prevent daytime accidents
• medications to help treat her constipation, such as polyethyline glycol 3350, a tasteless and odorless powder that can be mixed with water, or other stool softener or laxative
• counseling or an evaluation by another mental health professional to treat her possible depression and self esteem issues

Although she may someday outgrow all of these problems on her own, since they are having such a heavy toll on her mental health already, you should likely be aggressive in trying to find her help.