Children Encopresis & Constipation issue relating to Bedwetting

Constipation is a common complaint seen in primary care, accounting for approximately 3% to 10% of pediatric visits and more than 25% of referrals to gastroenterologists

When a child fails to defecate for several days or when the child's stool is hard, large, or painful upon defecation, the diagnosis of constipation can be made.

Furthermore, another accepted definition of constipation is fewer than three stools per week and/or hard, dry, pebbly fecal material for more than 2 weeks

Now kids who experiencing Nocturnal Enuresis NE (Bedwetting) and Diurnal Enuresis DE (Daytime time wetting) they have an immature urinary nervous system. Furthermore, kids who experience NE & or DE or both also are more likely experience Encopresis & Constipation has BM (Bowl Movements) accidents too!

Now relating to bedwetting the child stole put pressure against the bladder reducing the volume of the bladder and can contribute to over active bladder.

Parents are conscious of their child's stool patterns. Occasionally the lack of a daily bowel movement or misinterpretation of various physical signs (such as facial flushing and grunting in a normal infant) can be confused with constipation. Any deviation from what a parent considers to be normal alerts them to contact their health care provider for consultation.

Parents & children seem more affected with BM accidents. Parents find it stressful with others questioning their parenting skills and frustrating with the extra work load maintaining good hygiene.

Children are especial embarrassed with BM accidents. These accidents make them feel more babyish versus wetting accidents.

There simply more frustration with BM accidents where parents feel these could be avoided if they were more diligent paying attention to their bodily signals. Kids sometimes just don’t have control to hold it back when they get a signal.

What a doctor would look out for.

• Stool pattern
o Lack of a bowel movement for several days
o Size, number, consistency, and frequency of stools
o Associated history of rectal/abdominal pain or bleeding
o Soiling in the underwear
o Liquid stool ("diarrhea") and soiling, often alternating with hard stools (a sign of encopresis)

• Stool-holding behaviors
o Infants: extend legs and clutch buttocks together
o Toddlers: stand on tiptoes and rock while holding legs and buttocks stiffly

• Stomach aches or cramping

• Nausea and/or vomiting

• Bloating and anorexia

• Urinary tract symptoms

o Frequent urination
o Urinary tract infections
o Incontinence or enuresis

• Recent loss of appetite
• Weight loss or poor weight gain
• Unexplained fever
• Dietary habits
• Over-the-counter medication or herbal use

• Psychosocial factors

o Family structure and relationships
o In the school-aged child, classroom behaviors and use of the bathroom while at school

Physical Examination

• Abdomen
o Distention
o Tenderness
o Palpable mass (hard stool), usually supra-pubic

• Spine
o Spina bifida
o Tuft of hair, dimples

• Rectum (digital examination)
o Presence of hard fecal material
o Rectal dilatation
o Anal fissures or hemorrhoids
o Presence of anal wink
o Rectal prolapse

Diagnostic Tests
• Stool guaiac
• Urinalysis, urine culture
• Thyroid function studies
• Radiologic studies if organic cause suspected
o Kidneys, ureters, and bladder
o Barium enema

Steven F. Trimarco
Real Corporation
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