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Bedwetting Can be Due to "Hidden" Constipation, Research Shows

Hodges Steve James

Reporting in Urology, Wake Forest Baptist pediatric urologist Steve Hodges, MD, and colleagues found that 30 consecutive children and adolescents who sought treatment for bedwetting all had large amounts of stool in their rectums, despite the majority having normal bowel habits. After treatment with laxative therapy, 25 of the children (83 percent) were cured of bedwetting within three months. caption:

"Having too much stool in the rectum reduces bladder capacity," said Hodges. "Our study showed that a large percentage of these children were cured of nighttime wetting after laxative therapy. Parents try all sorts of things to treat bedwetting -- from alarms to restricting liquids. In many children, the reason they don't work is that constipation is the problem."

Definition of Constipation is Confusing

Hodges said the link between bedwetting and excess stool in the rectum was first reported more than 25 years ago by Dr. Sean O'Regan, but did not lead to a dramatic change in clinical practice, perhaps because the definition of constipation is not standardized or uniformly understood.

HOdges xray

Plain film abdominal radiography of child with normal bowel habits, but constipated according to Leech criteria and with rectal distension according to RPOR (line A/line B >1).

The definition for constipation is confusing and children and their parents often aren't aware the child is constipated," said Hodges. "In our study, X-rays revealed that all the children had excess stool in their rectums that could interfere with normal bladder function. However, only three of the children described bowel habits consistent with constipation."

Hodges said that guidelines of the International Children's Continence Society (which recommend asking if bowel movements occur irregularly and if the stool consistency is hard) focus on functional constipation and cannot help identify children with rectums that are enlarged and interfering with bladder capacity.  

Treating Constipation Can Cure Many Children of Bedwetting

"The kind of constipation associated with bedwetting occurs when children put off going to the bathroom. This causes stool to back up and their bowels to never be fully emptied. We believe that treating this condition can cure bedwetting in many children."

Children in the study ranged from 5 to 15 years old. Rectal size was measured on X-rays using a technique developed by Hodges and Wake Forest Baptist radiologists. Hodges said rectal ultrasound could also be used for diagnosis.
The constipated children were treated with an initial bowel cleanout using polyethylene glycol (Miralax®). In children whose rectums remained enlarged after this therapy, enemas or stimulant laxatives were used.

"The importance of diagnosing this condition cannot be overstated," Hodges said. "When it is missed, children may be subjected to unnecessary surgery and the side effects of medications. We challenge physicians considering medications or surgery as a treatment for bedwetting to obtain an X-ray or ultrasound first."

The authors cautioned that some cases may have improved on their own over time. They said a more accurate measure of the treatment's success would be to randomly assign constipated children to laxative therapy or an inactive therapy, an approach that would identify true response from cases that would resolve over time.

Hodges has written a book for consumers on bedwetting and other "potty" problems, " It's No Accident: Breakthrough Solutions To Your Child's Wetting, Constipation, UTIs, and Other Potty Problems," published by Globe Pequot Press.


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