Unrecognized Megarectum

Hodges and Anthony (2012) reviewed 30 patients’ bowel habits to identify megarectum (large rectal vault) and classic constipation symptoms. Constipation is a known cause of bedwetting. O’Regan first noted it in the 19080’s. Unfortunately, a thorough evaluation of constipation is no longer done for patients with bedwetting.  Providers typically ask, “any symptoms of constipation?” but that’s where the evaluation ends.  Hodges et al., showed that although only 10% of families reported symptoms of constipation, 100% actually met the diagnostic qualifications for having a megarectum. In this study 100% of adolescents were cured with laxatives and 80% of the younger patients were cured with laxatives. All patients were given a bowel clean out with miralax and then given daily miralax to keep the stools “milk shake” consistency.

My opinion: I suspect every child is constipated until proven otherwise. A little miralax every day can go a LONG way for kids that have bladder dysfunction overnight.  The trick is to take a laxative daily for 3-6 months to see the full effect to allow the bladder to heal. Families will request x-rays from the primary provider and the radiologist will read it as no obstruction no concerns but if they knew you wanted to know specifically about the rectum you would get a different report.  That’s why it’s important for a trained incontinence specialist to also review the image.

Hodges, S. J., & Anthony, E. Y. (2012). Occult Megarectum—A Commonly Unrecognized Cause of Enuresis. Urology, 79(2), 421-424. doi:10.1016/j.urology.2011.10.015