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Urologist on JonBenét Ramsey Bedwetting Theory: "Not Shocking"

Was JonBenét Ramsey killed because she wet the bed?

That apparently is a theory that police investigated following the tragic death of 6-year-old JonBenét at her home in 1996. According to a retired FBI profiler, bedwetting was a “nightly occurrence” with JonBenét. On the night she was killed, police theorized, Patsy Ramsey became so enraged that her daughter wet the bed again that she struck JonBenét, accidentally killing her.

Media outlets have called the theory “shocking.” I have no idea whether the theory has merit in JonBenét case, but as a pediatric urologist who specializes in bedwetting, I am not remotely shocked.

Bedwetting and toileting accidents are a leading cause of child abuse. I have a large collection of news reports on abuse cases related to bedwetting — children beaten, starved, or forced to sit in a chair all day, sleep in a bathtub, sit on an electric burner, stand for hours on an “X” on the kitchen floor.

These cases are extreme, but parental frustration is a very common response to bedwetting because there is a poor understanding — among parents, therapists, and even among some physicians — about what causes accidents in children.

Parents simply cannot imagine that a 6-year-old or 9-year-old or teenager could wet the bed — or pee or poop in their pants — without doing so willfully or being psychologically disturbed. So when the child has yet another incident, parents are sometimes pushed over the edge.

The facts: Bedwetting is never, ever the child’s fault, and it is not caused by stress, behavior problems, or defiance. (It is also, incidentally, not caused by deep sleep, hormonal problems.) Bedwetting is caused by chronic, severe constipation — a condition that is both epidemic in developed countries and yet routinely goes unnoticed.

Here’s how it develops: When the child suppresses the urge to poop, stool piles up in the rectum. A large, hard mass forms, stretching the rectum (think: rat in a snake’s belly) and pressing against and aggravating the bladder.

With the stretched rectum encroaching upon the bladder, the child can’t hold enough urine overnight. Also, the irritated bladder hiccups randomly and empties without warning — well before the child has a chance to wake up and run to the toilet.

Many children who wet the bed also have daytime pee and/or poop accidents. The stretched rectum loses tone and sensation, so the child stops sensing the need to poop, and even more stool piles up. Sometimes the rectum becomes so floppy that poop just drops out, without the child even noticing.

I X-ray all my bedwetting patients and those who have daytime accidents, and well over 90% of them are shown to be severely constipated. A rectal diameter of 3 cm or larger indicates a pile-up of stool; most of my bedwetting patients have rectums stretched 6 to 7 cm. I routinely see masses of stool as larger as a softball or grapefruit.

It is extremely eye-opening for parents to see these X-rays. As one of my patient’s moms put it, “Until you actually look at the film, it’s hard to understand. My 7-year-old was so stuffed with poop that his bladder was basically flattened. I could totally see why pee could not stay in there all night.”

Another mom, posted on our Facebook page: “Seeing the X-ray really decreased our frustration with our 5-year-old son. We thought his accidents were a behavior or anxiety issue. We all have better attitudes, as now view the wetting as a medical issue.”

Even though it is very clear (and proven by impeccable research) that constipation causes wetting, most of my patients are referred to me by pediatricians who missed the boat. The signs of constipation in children can be subtle. (See our infographic, 12 Signs a Child is Constipated.)

Giant masses of stool can hide in a child’s colon without anyone realizing it. A severely constipated child can poop daily and have a belly that looks and feels normal. And while infrequent pooping can be a sign of constipation, in fact, many severely constipated children poop multiple times a day, because they never fully empty.

Because few adults are aware of all this, children suffer blame when they have accidents. Many of my patients have been referred to behavioral therapists for what is clearly not a behavioral problem.

Even when children are on the receiving end of accusatory glances rather than beatings, they suffer. I see this daily in my practice. A young patient will sit on my exam table with shoulders slumped, staring at the ground, while Mom or Dad tells me, “He claims he doesn’t even feel it when he poops in his pants. That’s impossible to believe. ” Or, a parent will call the child “lazy” for wetting the bed, implying the child would rather lie there in wet sheets than get up and use the toilet. It is encounters like these that prompted me to write "Bedwetting and Accidents Aren't Your Fault."

I am not in a position to know whether JonBenét Ramsey was killed because she wet the bed. But if this is indeed what happened, it is particularly tragic because bedwetting, when treated properly, is an entirely fixable problem.

When you clean out the stretched, clogged rectum and allow it time to shrink back to size and regain tone and sensation, the accidents stop.

Steve Hodges, M.D., is an associate professor of pediatric urology at Wake Forest University School of Medicine and co-author, with Suzanne Schlosberg, of It's No Accident and Bedwetting and Accidents Aren't Your Fault.

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