Maybe you have been there, maybe your child has – tossing and turning trying hard to fall asleep but simply can’t.  You google to see why sleep is so hard to come by and several reasons flood your screen, but what if I told you that one of those reasons can be your digestive system?

Constipation is a common but very often overlooked condition that affects quality of sleep for all ages. There is an intricate relationship between our gut and our sleep patterns.

Sleep affects how well our digestive system works and the health of our digestive system affects the quality of our sleep. This means that any digestive issue can affect the nervous system that controls sleep. Further, insufficient sleep can increase the risk of constipation and constipation affects the quality of sleep.

 

How is Constipation Defined?

·         Frequency: Bowel movements occurring less frequently than normal. Some say less than 3 times a week, others say less than 2 times a week and yet others say 3 days or more between bowel movements. However, “normal” frequency varies from person to person and this needs to be taken into consideration. Ideally, we want to see 1-2 bowel movements a day (not a week but many individuals have chronic constipation and do not even realize it).  The accepted guideline tends to be fewer than 3 bowel movements a week.

·         Difficulty: Straining or struggling during a bowel movement. 

·         Incomplete Evacuation: Feeling like bowels have not fully emptied after elimination. Still feeling pressure in the area.

·         Abdominal Discomfort: Bloating, discomfort, or abdominal pain.

·         Stool Consistency: Passing hard, dry, pebble-like, lumpy, ball like, or oversized stool.

 

Signs of Constipation in Children:

Though, as adults, we tend to know when we are constipated it can be harder to identify in our children if we are not aware of what we should be looking for. Some signs to look for, in addition to the above include:

·         Avoidance of the toilet

·         Frequent gas and bloating

·         Stomachaches

·         Decreased appetite

·         Feeling “full” after little food intake

·         Stool leaking in underwear (child may or may not feel this)

·         Repeated urinary tract infections

·         Frequent urination

 

Causes of Constipation:

Constipation can be caused by several factors ranging from lifestyle and diet to underlying medical conditions. Some common causes include:

·         Diet: Low fiber intake, inadequate fluid intake (dehydration).

·         Lack of Physical Activity: Being active regularly helps stimulate the bowels.

·         Ignoring the Urge:  Suppressing the urge to go. This is common in those who fear public restrooms and in children.

·         Medications: Certain medications can cause constipation as a side effect.

·         Routine Changes: Traveling, changes in daily routine, or disruptions in regular meal times can affect regularity of bowel movements.

·         Stress: High levels of stress and anxiety can lead to constipation

·         Medical Conditions: Irritable Bowel Syndrome, hypothyroidism, diabetes, colorectal conditions and neurological disorders can cause constipation.

 

How Does Constipation Affect Sleep?

A growing body of evidence suggests that that an unhealthy balance of gut bacteria can lead to constipation, which, in turn, can disrupt sleep. (PMID:30809523).  Studies have also found that constipation commonly co-exists with decreased sleep quality and constipation rates were higher in people who slept too many or too little hours at night (PMID:36034289).

The discomfort and pain of constipation can become more pronounced when lying down and can make it challenging to relax and fall sleep. It can also disrupt the natural sleep-wake cycle as the person may have the urge to use the bathroom throughout the night or early in the morning. Constipation and sleep difficulties can worsen if the individual starts to use sleep aids or medication to manage insomnia

 

Elimination is not a Sleep Stall Tactic in Children

Most children start to gain control over their bowel movements between the ages of 18 months and 3 years. However, it's important to note that there is a wide range of normal development, and individual children may achieve this milestone at different times.

Here's a general timeline of bowel control development in children:

1. Infant Stage (0-18 Months): During the first months of life, infants have little to no control over their bowel movements. Bowel movements are typically reflexive.

2. Toddlers (18 Months - 3 Years): Most children begin to show signs of bowel control during this period. They may start to become aware of the sensations associated with having a bowel movement and may indicate when they need to go.

3. Preschool Age (3-5 Years): By the time children reach preschool age, many have developed the ability to fully control their bowel movements and can use the toilet independently. However, nighttime control (staying dry during sleep) may take longer to achieve.

4. School-Age Children (6 Years and Older): By the time children enter school, most are typically fully in control, including nighttime. However, occasional accidents can still occur, especially in stressful or unfamiliar situations.

 

Some reasons a child may have a bowel movement at nap time or night include:

 

1. Relaxation: During sleep, the body's muscles, including those in the digestive tract, may relax. This relaxation can sometimes trigger the natural bowel movements that were building up while the child was awake.

2. Circadian Rhythm: The body has a natural circadian rhythm that influences many bodily functions, including bowel movements. For some children, their body's internal clock may align with sleep, leading to a bowel movement at this time.

3. Diet: The timing of meals and the composition of a child's diet can influence bowel movements. Eating certain foods, especially high-fiber ones at night, may stimulate bowel activity.

4. Stress or Anxiety: In some cases, stress or anxiety can affect a child's digestive system, leading to changes in bowel habits. Sleep disturbances, including night waking for a bowel movement, can be a response to stress.

5. Gastrointestinal Conditions: Certain gastrointestinal conditions, like irritable bowel syndrome (IBS) or food sensitivities, can cause irregular bowel movements, including nighttime ones.

6. Age and Development: In infants and young children, the development of the digestive system may play a role. As their digestive system matures, bowel habits can change.

It's important to note that occasional nighttime bowel movements in children are not typically a cause for concern. However, if this becomes a persistent issue, or if it is accompanied by other concerning symptoms like pain, discomfort, or changes in stool consistency, it's best to consult a health care professional.

 

Relieving Constipation:

Relieving constipation often involves a combination of dietary, lifestyle, and, in some cases, medical interventions. Here are some strategies that can help relieve constipation:

1. Increase Dietary Fiber: Consume a diet rich in fiber, including fruits, vegetables, whole grains, and legumes. Fiber adds bulk to stool and promotes regular bowel movements.

2. Stay Hydrated: Drink plenty of water throughout the day. Adequate hydration helps soften stool, making it easier to pass.

3. Regular Mealtimes: Establish regular mealtimes to promote a consistent pattern of bowel movements. Eating at the same time each day can help regulate your digestive system.

4. Physical Activity: Engage in regular physical activity, such as walking or jogging, to stimulate bowel movements and promote overall digestive health.

5. Limit Processed Foods: Reduce the consumption of processed and low-fiber foods, as they can contribute to constipation.

6. Establish a Routine: Try to establish a regular bowel movement routine by sitting on the toilet at the same time each day, especially after meals when the body's natural urge to eliminate is often strongest.

7. Consult a Healthcare Professional: If constipation persists, worsens, or is accompanied by other concerning symptoms like bleeding, weight loss, or severe pain, consult a healthcare professional for a thorough evaluation to rule out underlying medical conditions.

 

It's important to remember that the effectiveness of any strategy can vary from person to person. What works for one individual may not work for another. What works for an adult may not work for a child. If you have chronic or severe constipation, or if you are unsure about how to manage it, it's advisable to seek guidance from a professional to determine the underlying cause and receive appropriate treatment.

In Wellness,

Tamara Jurkin