Think for a moment about the location of your bladder and the location of your rectum. Your rectum is where stool is held moments before you have a bowel movement. If your child’s bladder is trying to fill and there is a rectum full of stool, they have a high chance that they will wet themselves. I frequently hear, “my child is not constipated.” I’m not speaking specifically of constipation in the general term. I’m referring to a diagnosis called “megarectum.” Megarectum is when your rectum stretches out to hold more stool than what would be considered normal.
In practice, this a difficult diagnosis to make. Reviewing a child’s bowel history is very complicated. They generally don’t remember the last time the passed a stool and they rarely look at them. Their parents will assure me they have daily bowel movements, then I get an x-ray and see a large stool ball right behind their bladder.
How does this happen?
If a child holds their stool at school, delays pooping because they want to finish a video game, has a history of constipation, drinks little throughout the day and has a low fiber diet, they most likely have a megarectum. How do you know? It’s a hard topic to investigate and an x-ray isn’t the best answer. Megarectum is rarely commented on in a radiology report unless it’s severe. A child with a bladder dysfunction might be more sensitive to a rectum full of stool.
How do you know?
Monitor your child’s bowel movements for a week. Use the chart found here. The goal for a child with bladder dysfunction is a Type 4 or 5, every single day. If they are having large diameter stool, pebbles, infrequent stools, or painful stools it’s important to treat. You can speak with your primary provider about starting Miralax 1/2 capful to 1 capful a day. If your child is extremely backed up, a bowel cleanout would be very reasonable to help kick start their healing. Often times we will start it to take that off the table as a contributing factor.
How do you fix it?
Getting on track to have daily bowel movements takes a lot of effort by the parent. Remembering to give them their daily laxatives, encouraging hydration and enforcing daily sit times on the toilet to have a bowel movement are extremely important. We encourage kids to use a step stool so the poop will be easier to evacuate. I recommend the squatty potty because boys can still stand in front to void without it getting in the way. However, any step stool will work as long as they use it. Have them sit for 5-10 minutes after breakfast every day. It is recommended that you focus on laxatives and sit times for at least 6 months to heal the stretched out megarectum.
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Disclaimer: This does not replace appropriate evaluation by your medical provider. We do receive a small amount from our affiliate links to help pay to bring this information but all items are what I recommend to my patients.