Many thanks to Dr. Kiddoo for a helpful overview of the diagnostic and therapeutic considerations involved in managing enuresis in children.1 However, the importance of the abdominal examination, in particular the palpation for stool, was somewhat glossed over. The potential for a stool-laden rectum to cause or worsen enuresis in children has been recognized for many years.2 In a recent retrospective study, Hodges and Anthony3 found that a significant fecal load, even without a history of constipation, may contribute to the pathophysiology of enuresis, and that laxative treatment with polyethylene glycol can help in resolving nighttime bedwetting. They suggest that an abdominal radiograph is not an unreasonable investigation to consider in addition to urinalysis and culture. Clinicians may wish to keep this in mind when faced with children who present with nocturnal enuresis.
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