Elsevier

Urology

Volume 79, Issue 2, February 2012, Pages 421-424
Urology

Pediatric Urology
Occult Megarectum—A Commonly Unrecognized Cause of Enuresis

https://doi.org/10.1016/j.urology.2011.10.015Get rights and content

Objective

To determine whether occult megarectum remains a commonly unrecognized cause of enuresis and whether treating it will cure enuresis in most children. A landmark study proved constipation was a commonly unrecognized cause of enuresis in 1986 in which constipation was defined as abnormal rectal distension. However, modern recommendations have focused on signs of functional constipation, such as hard or rare stools.

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 and Leech criteria. These results were compared with the reported constipation history according to the International Children's Continence Society guidelines, which recommends asking parents and children whether the child's bowel movements occur less often than every other day and whether the stool consistency is hard. Patients diagnosed with megarectum were treated with laxatives, with the goal of restoring normal rectal tone.

Results

All patients demonstrated rectal distension according to the rectal/pelvic outlet ratio, and 80% were constipated according to the Leech criteria. Only 10% of the patient or families reported clinical symptoms of constipation. All the adolescent patients in our study and 80% of the younger patients were cured of enuresis with laxative therapy.

Conclusion

Occult megarectum remains a commonly undiagnosed cause of nocturnal enuresis. Abdominal radiographs represent a simple, noninvasive method to diagnose megarectum and might improve the treatment of nocturnal 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.

References (9)

There are more references available in the full text version of this article.

Cited by (0)

View full text