(RxWiki News) More than 5 million children in the US wet their beds at night, according to the National Institutes of Health. But a common cause of bedwetting may be going undetected.
While previous research has shown that constipation can contribute significantly to “nocturnal enuresis,” or nighttime bedwetting, a recent study suggests that families and physicians may be overlooking this connection.
"Look into constipation cures for bedwetting problems."
Steve Hodges, MD, assistant professor of urology at Wake Forest Baptist Medical Center in Winston-Salem, North Carolina, and his coauthor, radiologist Evelyn Anthony, MD, studied 30 children and adolescents, ages 5 to 15, who were dealing with bedwetting issues.
Only three of the children described bowel habits consistent with constipation, according to Dr. Hodges. Yet abdominal x-rays revealed that all these young patients had excess stool in their rectum that could be interfering with normal bladder function.
After treatment with laxative therapy, 25 of the patients (83 percent) were cured of bedwetting within three months.
Laxative treatment consisted of an initial bowel cleanout using polyethylene glycol (Miralax), which softens stools. The children whose rectums remained enlarged after this therapy received enemas or stimulant laxatives.
“Parents try all sorts of things to treat bedwetting—from alarms to restricting liquids,” said Dr. Hodges. “In many children, the reason they don't work is that constipation is the problem. Having too much stool in the rectum reduces bladder capacity. We believe that treating this condition can cure bedwetting."
Dr. Hodges suggests that current guidelines to identify constipation are insufficient. The International Children's Continence Society recommends asking children and their parents if the child's bowel movements occur irregularly (less often than every other day) 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," said Dr. Hodges, who is also the author of the book It's No Accident: Breakthrough Solutions To Your Child's Wetting, Constipation, UTIs, and Other Potty Problems.
Dr. Hodges recognizes that results for his analysis are based on a small population of 30 children and that some of the patients may have improved over time without laxative treatment.
While a larger study may provide more conclusive results, Dr. Hodges advocates that physicians obtain an abdominal x-ray or ultrasound first before considering medications or surgery as a treatment for bedwetting.
"The importance of diagnosing this condition cannot be overstated," he said. "When it is missed, children may be subjected to unnecessary surgery and the side effects of medications.”
This study was published in the February 2012 edition of the journal Urology. No conflicts of interest were noted.