In a child with bed-wetting and constipation, which treatment is most appropriate as first-line?

• A. Osmotic laxative
• B. Behavioral therapy
• C. Antibiotics
• D. Antihistamines

Answer: (A)

Constipation can significantly impact urinary control in children. When stool builds up in the rectum, it can press on the bladder, reduce its capacity, and trigger overflow incontinence, leading to bed-wetting. The first step is to relieve the constipation, which often improves or resolves nocturnal enuresis. An osmotic laxative works best as initial therapy because it draws water into the bowel, softens stool, and promotes regular, easy bowel movements, addressing the root cause of the urinary symptoms.

Behavioral strategies for enuresis can help, but they don’t treat the underlying bowel issue. Antibiotics aren’t indicated, since there’s no infection to treat, and antihistamines aren’t relevant to this problem. Once constipatio n improves, bed-wetting typically improves as well, and other enuresis-focused interventions can be added if needed.