“Most of these kids did not have symptoms consistent with constipation and the parents had no clue,” says researcher Steve J. Hodges, MD, an assistant professor of urology at Wake Forest Baptist Medical Center in Winston-Salem, N.C. “What these children had was stool in their rectums, and that is the problem we addressed in this study.”
Hodges says stool left in the lower intestine, or rectum, can push against the bladder and reduce its capacity to hold urine.
He says even though it has been known for more than two decades that this might be a cause of bed-wetting, few doctors consider this when evaluating children with the condition.
Since normal constipation symptoms, such as infrequent or very hard stools, do not always predict whether a child will have stool in the rectum, Hodges and diagnostic radiologist Evelyn Anthony, MD, conducted abdominal X-rays to confirm it.
Their study included 30 children ranging in age from 5 to 15 (the average age was 9) being evaluated for bed-wetting at the Wake Forest Baptist Medical Center.
X-rays revealed that all of the children had some degree of rectal expansion caused by stool. Four out of five demonstrated stool burden consistent with constipation, despite the fact that just 1 in 10 had a history of constipation symptoms.
When the children received laxatives or enemas to treat the issue, 25 of the 30 (83%) were no longer wetting the bed within three months.
The study appears online in the journal Urology.
Hodges says he has used the approach to successfully treat close to 200 cases of bed-wetting and urinary reflux -- a condition characterized by abnormal flow of urine from the bladder back toward the kidneys.
“I haven’t had to operate on a child for reflux in a very long time because when we empty their rectums the reflux resolves,” he tells WebMD.