Some bedwetting in kids may be caused by constipation

Undiagnosed constipation, rather than problems with the bladder, may be to blame for nocturnal enuresis in some children, say researchers from Wake Forest Baptist Medical Center, Winston-Salem, NC.

The authors found that 30 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%) were cured of bedwetting within 3 months.

"Having too much stool in the rectum reduces bladder capacity," said lead author Steve J. Hodges, MD. "Our study showed that a large percentage of these children were cured of nighttime wetting after laxative therapy.

"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," added Dr. Hodges of the results, which were published in Urology (2012; 79:421-4).

Dr. Hodges explained that guidelines of the International Children’s Continence Society recommend asking children and their parents if the child’s bowel movements occur irregularly and if the stool consistency is hard.

“These questions focus on functional constipation and cannot help identify children with rectums that are enlarged and interfering with bladder capacity,” he said. “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.”

Children in the study ranged from 5 to 15 years of age. The constipated children were treated with an initial bowel cleanout using polyethylene glycol (Miralax). Enemas or stimulant laxatives were used in children whose rectums remained enlarged after this therapy.

"The importance of diagnosing this condition cannot be overstated," Dr. 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."

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