Wetting Accidents

Wetting Accidents and Encopresis

Wetting accidents ("peeing in one's pants") at night and/or during the day may be a symptom of encopresis (functional constipation). 

Nighttime wetting and daytime dripping or leaking are frequently due to a distended or stretched rectum caused by stool withholding. This is because the rectum and the urinary bladder are physically very close together. (See Chapter 9, page 66)  If one or both of these organs are full they can easily press up against one another, increasing the chance of accidental wetting.  I find that these accidents occur more frequently with children who wait until the last second to urinate.

It is also important to know that pressure on the urinary bladder by a distended rectum can make it difficult for the bladder to empty completely. Over time, especially for girls, incomplete emptying of the bladder can lead to a bacterial infection in the residual urine, commonly known as a urinary tract infection (UTI). 

Since sudden onset daytime wetting accidents can also be caused by a urinary tract infection (UTI) parents would be wise to seek the opinion of their pediatric healthcare provider if the daytime accidents continue.

Painful constipation, soiling and daytime wetting: Q&A with Dr Tom

A parent recently asked me if soiling at home but not at school and frequent daytime wetting might be related to "painful constipation":

Question: My daughter had some painful constipation several months back which seemed to be the beginning of her soiling issues. After that time she started soiling frequently, as many as 4 or 5 times a day. She is soiling less now but there are two questions I have about the soiling. The first is that she rarely soils at daycare, she typically only soils at home. The second is that she is now wetting her pants frequently, something she didn't do when she started soiling. I think that all of her soiling issues point back to those constipation issues but I don't know if these two behaviors are in line with that idea.

Answer: Painful bowel movements will often lead to withholding followed by soiling (encopresis). Since your daughter continues to soil, albeit less than at first, she is still constipated.That she tends not to soil at school is also typical in the early stages of functional constipation. Ongoing withholding and soiling are often associated with day and night wetting. This is because a distended or stretched rectum will press on the bladder causing occasional leaking during the day and/or bedwetting at night. This is all covered in my book.