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My 5-year-old is so constipated that he cries!
Q: My 5-year-old son has difficulty with bowel movements. Sometimes he has such a hard time that he cries. He only sits on the toilet for a minute before asking for a pull-up. Should I make him sit longer? He also wets his bed and gets upset when he has an accident.
A: Constipation and bedwetting are common problems, even at 5 years old and older. They’re often related, too. Studies have found that children who are constipated are more likely to wet the bed.

Constipation is when the bowel movements are large, hard and difficult to pass. Sometimes the hard stool can cause cracking of the skin, which can make it even more painful. Since a child’s rectum and bladder are very close to each other, a rectum that is full of stool from constipation can push on the bladder and the surrounding nerves and muscles. This can send confusing signals to the bladder and brain, which interferes with bladder control and leads to bedwetting.

Understandably, your son’s constipation and bedwetting can be upsetting to him. It’s important for you to be supportive and careful not to embarrass or punish him. Let your son know that this is not his fault, and you’ll work with the doctor to try to make it better. Talk with your son’s doctor right away. Since the constipation could cause the bedwetting, the doctor may start by treating the constipation.

Depending on how much hard stool there is in your son’s rectum, the doctor might recommend clearing it out with an enema or rectal suppository, and/or starting your son on a stool softener such as mineral oil or a laxative. In addition, she will recommend a diet to help soften his stools to prevent constipation, including more whole-grains, fruits and vegetables, and fewer constipating foods such as milk, yogurt, cheese, rice and bananas. In addition, your son should drink plenty of liquids during the day, such as water or a cup of apple or prune juice. Switching from cow’s milk to soy milk might also help.

Make sure your son gets physical activity every day. When the body moves, the bowels move better, too. Encourage your son to have regular bowel patterns by sitting on the toilet for five to 10 minutes after breakfast and dinner. You might use incentives such as special books to read or tapes to listen to, and a daily calendar with stars or stickers for sitting on the toilet and having a bowel movement. The doctor will work with you to set up a plan for treating the constipation and following the improvement.

Relieving your son’s constipation might eliminate his bedwetting problem. If he still continues to wet the bed, work with your doctor to address that problem. This might involve tests to make sure the bedwetting isn’t caused by a medical problem, limiting evening liquids and having him urinate before bed. Also ask the doctor about a bed alarm and medications, which have been successful for many children.

Karen Sokal-Gutierrez M.D., M.P.H. Pediatrician