Pediatric UrologyOccult Megarectum—A Commonly Unrecognized Cause of Enuresis
Section snippets
Material and Methods
A retrospective review of 30 consecutive patients seen in our clinic with a chief complaint of nocturnal enuresis was performed, with an analysis of the results of their plain abdominal radiographs. The results of the studies were determined using a novel method termed the rectal/pelvic outlet ratio (RPOR). The RPOR is a ratio of the measurement of the rectum at its widest point when distended by stool, over the pelvic outlet (defined as the distance between the obturator stripes at the level
Results
We reviewed the charts of 30 patients, 19 boys and 11 girls, referred to our clinic for nocturnal enuresis. Their age range was 5-15 years (average age 9). Four of the patients were adolescents.
All radiographs demonstrated fecal rectal distension, as defined by an RPOR >1. Of the abdominal radiographs, 80% demonstrated an abnormal fecal burden (as defined by the Leech criteria), consistent with constipation. Only 10% of the parents or children with abnormal radiographs described a bowel history
Comment
The current belief is that nocturnal enuresis arises from a combination of 3 main causes: nocturnal polyuria, detrusor overactivity, and an increased arousal threshold.1, 2 All studies agree, however, that comorbid conditions can influence these factors (eg, the effects of constipation on bladder capacity and overactivity) and must be treated before initiating direct therapy, because it might be difficult to succeed otherwise.2
Several dilemmas are inherent in the evaluation of children for
Conclusions
Occult megarectum, initially described by O'Regan et al3 in 1986, remains a commonly undiagnosed cause of nocturnal enuresis. We believe abdominal radiography is a safe and integral method to diagnose megarectum in children with nocturnal enuresis and have used it as a part of our standard care of these patients.
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