Constipation could be a major cause of bedwetting, according to a report in the journal Urology. Steve J. Hodges, MD, and colleagues at the Wake Forest Baptist Medical Center in Winston-Salem, NC, studied 30 children ages 5-15 who were being evaluated for bedwetting at the Center. Surprisingly, all had retained abnormal amounts of stool although just three of the children had a history of constipation symptoms.
When the chldren received laxatives or enemas for their constiptation, 25 of the 30 no longer wet their beds after three months. "Having too much stool in the rectum reduces bladder capacity," explains Dr. 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."
"The importance of diagnosing this condition cannot be overstated," adds Dr. Hodges. "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 study used abdominal X-rays to identify the children with excess stool in their rectums. Dr. Hodges and radiologists at Wake Forest Baptist developed a special diagnostic method that involves measuring rectal size on the X-ray. He said rectal ultrasound could also be used for diagnosis.
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.
Some 15% of children are affected by bedwetting before puberty. It is more common among boys, and tends to occur in families.
► See a Wake Forest Baptist Medical Center news release announcing the study's findings.
