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Abstract

We wished to investigate the urodynamic characteristics and colonic motility in a group of children with severe chronic constipation and lower urinary tract symptoms. We performed colonic manometry using an endoscopically placed catheter. The urodynamic studies consisted of cystometry, electromyography of the external urethral sphincter, measurement of urinary flow rate, and urethral pressure profile. We found abnormal colonic motility in all patients. Findings included: absent gastrocolonic response (N = 8), absent high-amplitude propagated contractions (HAPCs) (N = 4), and abnormal propagation of HAPCs (N = 7). Urodynamic features were abnormal in 10 children. Findings included: uninhibited bladder contractions (N = 6), hypertonic bladder (N = 2), sphincter dyssynergy (N = 2), small capacity bladder (N = 1). In all children constipation improved, in three after a partial colectomy. Urinary symptoms persisted. We conclude that some children with severe constipation may have a neuropathy affecting both the colonic and lower urinary tracts systems. In this group of patients treatment of constipation does not result in resolution of urinary symptoms.

Association of Bowel Habits with Lower Urinary Tract Symptoms in Men: Findings from the 2005–2006 and 2007–2008 National Health and Nutrition Examination Survey

“…Constipation is reported in 30% to 88% of children with bladder dysfunction, 12 and children with constipation have higher rates of concomitant fecal and urinary incontinence than those without. 13 It is theorized that either rectal distention places direct pressure on the posterior bladder wall, leading to detrusor overactivity and urinary retention, 14 or that prolonged anal sphincter contraction in the presence of a large stool bolus leads to inappropriate pelvic floor muscle contraction and secondary detrusor-sphincter dyssynergia. 15 Aggressive bowel treatment programs have been shown to decrease urinary symptoms significantly in children.…”

Effect of constipation on acute urinary retention following transrectal prostate biopsy

“…It is possible that any pathology or dysfunction in one of the organs could affect the other as the urinary bladder and rectum are the neighboring organs which develop from common embryological structures in the cloaca. The following theories have been proposed in some studies investigating the co-existence of bladder and bowel dysfunction together in pediatric patients and these may also be adapted to elderly patients suffering from CC; The first suggests that rectal distention in the constipated patient compresses bladder outlet and urethra, leading to impaired bladder emptying [ 26 ]. The second theory assumes that urethral and anal sphincteric neural input is a single functional unit being innervated by parasympathetic nerves originating from S2 to S4.…”