Too little water is causing bedwetting

I can remember waking up with a sopping wet cold patch in the bed, on more than one occasion as a child. I felt humiliated as I watched my mother angrily strip the linen off the bed.

Accidents happen, but when they’re still happening on a nightly basis after the age of 5, something is clearly wrong.

Most of the time the assumption is that it is the bladder which is misfiring. Liquid restriction is the first line of defence – ironically this approach may end up exacerbating the problem.

The bladder is being pushed

Researchers from Wake Forest Baptist Medical Centre turned their attention away from the bladder to the adjacent pipes i.e. the rectum.

The team performed X-ray studies of the lower abdomen in 30 serial bedwetters, ranging in age from 5 – 15 years. Ouch ! Imagine being 15 years old and still wetting the bed.

The kids all had big loads on board. The X-ray revealed the rectum contained excess stool i.e. the kids were effectively constipated.

Interestingly only 3 of the children’s bowel habits, suggested they were officially constipated. To be diagnosed with constipation, bowel habits must occur irregularly (less often than every other day) and the stool should be hard.

Emptying the gut solves the problem

So the rectum is a little full – bedwetting is about peeing, not poohing. Well, it turns out a full rectum, squishes the bladder, decreasing its’ holding capacity, which is what is causing the uncontrolled voiding of urine during the night.

Emptying the rectum, relieves the bedwetting problem most of the time.

The research team treated the bedwetters with a course of laxative therapy. The protocol they used involved polyethylene glycol (Miralax®), this drug causes more water to be retained by the gut, making the stool soft and squishy. Soft squishy stools are able to slide out of the rectum more easily, leaving it completely empty. The empty rectum automatically increases the bladder’s capacity, increasing the odds of making it through the night without “an accident”.

25 of the bedwetters were “cured” following the laxative treatment, that translates to 80 %, pretty effective.

Failing to go, causes going in the night

Managing bedwetting typically begins with restricting fluids – the thinking being less water in, less water out. But less water in, can also cause the stool to be a little harder, potentially contributing further to the problem.

But, this type of constipation is more than likely caused by bathroom avoidance i.e. put off going when the urge arises. Ignoring the signals to go, causes the stool to accumulate in the bowel, so that even when going, it is never completely emptied.

Laxatives need to be used with caution

Laxatives can be purchased over the counter and are considered to be relatively safe.

However, they disrupt the normal flow of things, especially if they are used on a long term basis. “Forced” evacuations can cause good stuff to be lost and create a situation where the gut becomes dependent on outside “forces”.

Dosing your child with laxatives long term, is not a good idea. But if a little laxative therapy can cure 80 % of the bedwetters in this study, it is probably worth a try. Discuss the option with your doctor.

Occult Megarectum—A Commonly Unrecognized Cause of Enuresis. Urology (2011) 79(2):421-424.  Steve J. Hodges, Evelyn Y. Anthony. 

 

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Further reading

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