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Children with enuresis - are they more constipated than others?
Malin Borgström1, Maria Tunebjer2, Barbro H Skogman3
1Department of Women's and Children's Health, Uppsala University, Box 256, 751 05, Uppsala, Sweden; Center for Clinical Research Dalarna, Uppsala University, Nissers väg 3, 791 82, Falun, Sweden.
Insights
Constipation is not more common in children with enuresis (bedwetting). However, children with enuresis showed smaller functional bladder capacities, suggesting potential detrusor overactivity.
Area of Science:
- Pediatric Urology
- Gastroenterology
- Child Health
Background:
- The relationship between bowel function and bladder control is recognized, with constipation linked to daytime incontinence and urinary tract infections.
- The specific connection between constipation and enuresis (bedwetting) remains less understood.
- It is hypothesized that a full bowel may influence bladder function, but this link's applicability in enuresis requires investigation.
Purpose of the Study:
- To determine if constipation is more prevalent in children experiencing enuresis compared to healthy children without bladder issues.
- To compare the prevalence of constipation in children with enuresis against a control group of children without bladder problems.
Main Methods:
- A case-control study involving children with enuresis and healthy controls from the same geographic area.
- Rectal diameter was measured using abdominal ultrasound for all participants.
- Bowel movements and bladder function were recorded at home over two weeks and two days, respectively.
Main Results:
- No significant difference in rectal diameter or constipation prevalence (Rome IV criteria) was found between the enuresis group (66 children) and controls (58 children).
- Children with enuresis reported fewer bowel movements per two weeks compared to controls.
- Children with enuresis exhibited smaller voided volumes relative to their expected bladder capacity.
Conclusions:
- The study did not find evidence supporting a higher prevalence of constipation in children with enuresis.
- A decreased functional bladder capacity was observed in children with enuresis.
- This reduced bladder capacity may indicate detrusor overactivity in children with enuresis.
Introduction:
The bowel-bladder interaction is well established, as is the fact that constipation can lead to daytime incontinence and/or recurrent urinary tract infections. However, the link between constipation and enuresis is less clear. The bowel's influence on enuresis is possibly important even though fecal disimpaction by itself will not make the child dry at night. Furthermore, parents and patients may be unaware of the child's constipation until the enuresis is evaluated. The same should apply to healthy children. The hypothesis that a full bowel affects bladder function appears to be logical; however, this may not be applicable in enuresis. A crucial question is if constipation is more common among children with enuresis than in the general population.
Aim:
To evaluate the prevalence of constipation in children with enuresis as compared to children without bladder problems.
Subjects And Methods:
In this case-control study the former group was recruited from a pediatric clinic and the latter from the general population in the same geographic area. All children had their horizontal rectal diameter measured via abdominal ultrasound. Their bowel movements over two weeks and bladder function over two days were recorded at home.
Results:
We recruited 66 children with enuresis and 58 healthy controls. The ages ranged from 6 to 11 (mean 7.3 ± 1.3) years and 50 (40 %) of them were girls. The groups had no difference in rectal diameter (28.9 ± 7.7 vs 28.2 ± 10.1 mm, P = 0.672) and they had a similar prevalence of constipation according to the Rome IV criteria. The children with enuresis had fewer bowel movements per two weeks (11.2 ± 4.1 vs 14.8 ± 6.9, P < 0.001) than controls, but they had no more constipation symptoms. However, bladder diaries showed that children with enuresis had smaller voided volumes (87.1 ± 31.8 vs 127.5 ± 44.5 % of expected bladder capacity; P < 0.001) than controls.
Conclusion:
We did not find support for constipation being more prevalent among children with enuresis than controls. But we did find decreased functional bladder capacity in patients with enuresis which may be an indirect sign of detrusor overactivity.
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