Introduction
Methods
Study design and population
Ethics statement
Web-based electronic patient records
Data analyses
Results
Baseline patient characteristics
Participants
Total | 1-HC | 2-HC | 3-HC |
P valuea
| ||
---|---|---|---|---|---|---|
n = 1748 |
n = 731 |
n = 906 |
n = 111 | |||
(41.7) | (51.9) | (6.4) | ||||
Participants | ||||||
Age (years) | Mean ± SD | 7.7 ± 2.9 | 7.5 ± 2.9 | 7.8 ± 2.8 | 7.9 ± 3.2 | 0.27 |
Boys | 855 (48.9) | 385 (52.6) | 414 (45.4) | 56 (51.3) | ||
Age (years) | Mean ± SD | 7.6 ± 2.8 | 7.4 ± 2.8 | 7.9 ± 2.8 | 7.6 ± 2.9 | 0.25 |
Girls | 893 (51.1) | 345 (47.3) | 493 (53.6) | 55 (48.7) | ||
Age (years) | Mean ± SD | 7.7 ± 2.9 | 7.6 ± 3.0 | 7.8 ± 2.8 | 8.2 ± 3.5 | 0.27 |
Parentsb
| Single parent | 113 (6.7) | 46 (6.7) | 59 (6.7) | 8 (7.1). | |
Two parents | 1429 (85.1) | 589 (85.7) | 749 (84.8) | 91 (83.5) | ||
Newly formed family | 137 (8.2) | 52 (7.6) | 75 (8.5) | 10 (7.3) | ||
Siblings | 1481 (88.2) | 603 (87.8) | 779 (88.2) | 99 (90.8) | 0.39 | |
Problems at homec
| 236 (13.5) | 96 (13.2) | 128 (14.1) | 12 (5.1) | 0.27 | |
Childhood bladder and bowel dysfunctions (physicians’ diagnoses) | ||||||
Daytime urinary incontinence | 602 (34.3) | 274 (37.6) | 296 (32.6) | 32 (28.3) | 0.039*
| |
Constipation | 549 (31.4) | 164 (22.5) | 341 (37.6) | 44 (38.9) | <0.001* | |
Enuresis | 493 (28.2) | 243 (33.3) | 229 (25.2) | 21 (18.9) | <0.001* | |
Fecal incontinence | 362 (20.7) | 159 (21.8) | 178 (19.6) | 25 (22.1) | 0.51 | |
Increased voiding frequency | 267 (15.3) | 114 (15.7) | 141 (15.5) | 12 (10.6) | 0.37 | |
Urinary tract infections | 210 (12.0) | 48 (6.6) | 142 (15.7) | 20 (17.7) | <0.001*
| |
Abdominal pain | 457 (26.1) | 163 (22.4) | 259 (28.6) | 35 (31.0) | 0.009*
| |
Withholding behavior | ||||||
At least one bladder dysfunction | 1122 (64.2) | 486 (66.8) | 572 (63.1) | 64 (55.6) | 0.069 | |
At least one bowel dysfunction | 793 (45.4) | 286 (36.1) | 445 (49.1) | 62 (54.9) | <0.001*
| |
CBBD | 321 (18.4) | 116 (15.9) | 183 (20.2) | 22 (19.5) | 0.083 | |
Other health problemsd
| 126 (7.4) | 26 (3.7) | 80 (8.8) | 20 (18.7) | <0.001*
| |
Medicatione
| Bladder | 183 (10.5) | 77 (10.6) | 89 (9.8) | 17 (15.0) | 0.23 |
Bowel | 787 (45.4) | 287 (39.7) | 440 (48.9) | 60 (53.1) | <0.001* | |
Parent-completed SDQ, age 4–16 years | ||||||
Analyzed = 1559 | Range | |||||
close to average to slightly raised | 0–16 | 1386 (88.9) | 547 (87.1) | 749 (90.0) | 90 (90.9) | |
high to very high | 17–40 | 173 (11.1) | 81 (12.9) | 83(10.0) | 9 (9.1) | |
Total difficulties score | 0–40 | 9.2 ± 5.7 | 9.5 ± 5.8 | 9.0 ± 5.7 | 8.5 ± 5.5 | 0.15 |
Referring physicians’ diagnoses
Gender | Total | 1-HC | 2-HC | 3-HC |
P valuea
| |
---|---|---|---|---|---|---|
n = 1748 |
n = 731 |
n = 906 |
n = 111 | |||
(41.8) | (51.9) | (6.4) | ||||
Childhood Bladder and Bowel Dysfunctions (physicians’ diagnoses) | ||||||
Daytime urinary incontinence | B versus Gb
| 0.65 | ||||
boys | 229 (35.0) | 138 (36.0) | 147 (35.5) | 14 (24.1) | 0.20 | |
girls | 303 (33.9) | 136 (39.4) | 149 (30.2) | 18 (32.7) | 0.022*
| |
Constipation | B versus Gb
| <0.001*
| ||||
boys | 225 (26.3) | 56 (14.5) | 149 (36.0) | 20 (35.7) | <0.001*
| |
girls | 324 (36.6) | 108 (31.3) | 192 (38.9) | 24 (43.6) | 0.039*
| |
Enuresis | B versus Gb
| <0.001* | ||||
boys | 320 (37.4) | 160 (41.6) | 147 (35.5) | 13 (23.2) | 0.016* | |
girls | 173 (19.4) | 83 (24.1) | 82 (16.6) | 8 (14.5) | 0.018* | |
Fecal incontinence | B versus Gb
| <0.001*
| ||||
boys | 232 (27.1) | 104 (27.0) | 113 (27.3) | 15 (26.8) | 0.048* | |
girls | 130 (14.6) | 56 (16.2) | 65 (13.2) | 9 (16.4) | 0.22 | |
Increased voiding frequency | B versus Gb
| 0.51 | ||||
boys | 136 (15.9) | 56 (14.6) | 74 (17.9) | 6 (10.3) | 0.23 | |
girls | 131 (14.7) | 58 (16.8) | 67 (13.6) | 6 (10.9) | 0.32 | |
Urinary tract infections | B versus Gb
| <0.001*
| ||||
boys | 18 (2.1) | 6 (1.6) | 11 (2.7) | 1 (1.7) | 0.63 | |
girls | 192 (21.5) | 42(12.2) | 131(26.6) | 19 (34.5) | <0.001*
| |
Abdominal pain | B versus Gb
| <0.001*
| ||||
boys | 167 (19.5) | 61 (15.9) | 93 (22.5) | 13 (22.4) | 0.056 | |
girls | 290 (32.5) | 102 (29.6) | 166 (33.7) | 22 (40.0) | 0.22 | |
Withholding behavior | B versus Gb
| 0.71 | ||||
boys | 234 (27.4) | 121 (31.4) | 102 (24.6) | 11 (19.6) | 0.040*
| |
girls | 252 (28.2) | 124 (35.9) | 110 (22.3) | 18 (32.7) | <0.001*
| |
At least one bladder dysfunction | B versus Gb
| 0.32 | ||||
boys | 554 (64.8) | 265 (68.8) | 260 (62.8) | 29 (51.8) | 0.022*
| |
girls | 568 (63.6) | 222 (64.3) | 312 (63.3) | 34 (61.8) | 0.91 | |
At least one bowel dysfunction | B versus Gb
| 1.0 | ||||
boys | 388 (45.4) | 142 (36.9) | 214 (51.7) | 32 (56.9) | <0.001*
| |
girls | 405 (45.4) | 145 (42.0) | 231 (46.9) | 29 (52.7) | 0.20 | |
Both, bladder and bowel dysfunction | B versus Gb
| 0.76 | ||||
boys | 160 (18.7) | 63 (16.4) | 88 (21.3) | 9 (16.1) | 0.18 | |
girls | 161 (18.0) | 54 (15.7) | 95 (19.3) | 12 (21.8) | 0.30 |
Strength and Difficulties Questionnaire
Parent-reported symptoms
Total | 1-HC | 2-HC | 3-HC |
P valuea
| |
---|---|---|---|---|---|
n = 1748 |
n = 730 |
n = 907 |
n = 111 | ||
Items of the Childhood Bladder and Bowel Dysfunction Questionnaireb
| |||||
1 Passes urine more than 8 times during the day | 676 (38.7) | 289 (39.6) | 355 (39.1) | 32 (28.8) | 0.087 |
2 Wets underwear and /or outer clothing during the day | 859 (49.1) | 383 (52.5) | 430 (47.4) | 46 (41.4) | 0.031* |
3 Loses some drops of urine immediately after urinating has finished | 684 (39.1) | 302 (41.4) | 347 (38.3) | 35 (31.5) | 0.40 |
4 Loses urine within the hour after urinating has finished | 518 (29.6) | 225 (30.8) | 267 (29.4) | 26 (23.4) | 0.28 |
5 Seems to ignore the urge to urinate | 927 (53.0) | 407 (55.8) | 473 (52.1) | 47 (42.3) | 0.023* |
6 Uses tricks to stay dry, like wriggling or forcefully crossing the legs | 597 (34.2) | 261 (35.8) | 303 (33.4) | 33 (29.7) | 0.36 |
7 Experiences a sudden uncontrollable urge to urinate | 989 (56.6) | 422 (57.8) | 510 (56.2) | 57 (51.4) | 0.42 |
8 Postpones first urination in the morning | 505 (28.9) | 203 (27.8) | 268 (29.5) | 34 (30.6) | 0.68 |
9 Wets the bed or diaper during sleeping periods | 742 (42.4) | 339 (46.4) | 362 (39.9) | 41 (36.9) | 0.014* |
10 Wakes up at night to urinate | 353 (20.2) | 128 (17.5) | 203 (22.4) | 22 (19.8) | 0.052 |
11 Has two or fewer bowel movements per week | 373 (21.4) | 169 (23.2) | 176 (19.4) | 28 (25.2) | 0.11 |
12 Stains or soils the underwear with stools | 778 (44.5) | 335 (45.9) | 385 (42.4) | 58 (52.3) | 0.09* |
13 Has hard stools or painful bowel movements | 414 (23.7) | 150 (20.5) | 232 (25.6) | 32 (28.8) | 0.025* |
14 Has large amounts of stool (that may obstruct the toilet) | 345 (19.7) | 147 (20.1) | 168 (18.5) | 30 (27.0) | 0.10 |
15 Postpones bowel movements | 616 (35.2) | 292 (40.0) | 286 (31.5) | 38 (34.2) | 0.002* |
16 Experiences a sudden uncontrollable urge to defecate | 763 (43.7) | 326 (44.7) | 389 (42.9) | 48 (43.6) | 0.77 |
17 Has abdominal pain | 699 (40.1) | 270 (37.1) | 383 (42.3) | 46 (41.4) | 0.10 |
18 Has a bloated belly | 415 (23.7) | 157 (21.5) | 214 (23.6) | 44 (39.6) | <0.001* |
At least one bladder symptom | 1566 (89.6) | 668 (91.5) | 805 (88.8) | 93 (83.8) | 0.023* |
At least one bowel symptom | 1404 (80.3) | 589 (80.7) | 722 (79.6) | 93 (83.8) | 0.55 |
Combined bladder and bowel symptom | 1266 (72.4) | 539 (73.8) | 647 (71.3) | 80 (72.1) | 0.53 |
Gender | Total | 1-HC | 2-HC | 3-HC | P valuea
| |
---|---|---|---|---|---|---|
n = 1748 |
n = 730 |
n = 907 |
n = 111 | |||
Items of the Childhood Bladder and Bowel Dysfunction Questionnaireb
| ||||||
1 Passes urine more than 8 times during the day | B versus Gc
| 0.057 | ||||
boys | 350 (40.9) | 163 (42.3) | 170 (41.1) | 17 (30.4) | 0.23 | |
girls | 326 (36.5) | 126 (36.5) | 185 (37.5) | 15 (27.3) | 0.33 | |
2 Wets underwear and /or outer clothing during the day | B versus Gc
| 0.006*
| ||||
boys | 449 (52.2) | 213 (47.4) | 212 (48.8) | 32 (57.1) | 0.17 | |
girls | 410 (45.9) | 170 (49.3) | 218 (44.2) | 22 (40.0) | 0.23 | |
3 Loses some drops of urine immediately after urinating finished | B versus Gc
| 0.003*
| ||||
boys | 490 (57.3) | 173 (44.9) | 173 (41.8) | 19 (33.9) | 0.26 | |
girls | 319 (35.7) | 129 (37.4) | 174 (35.3) | 16 (29.1) | 0.47 | |
4 Loses urine within the hour after urinating has finished | B versus Gc
| 0.08 | ||||
boys | 270 (31.6) | 122 (31.7) | 131 (31.6) | 17 (30.4) | 0.98 | |
girls | 248 (27.8) | 103 (29.9) | 136 (27.6) | 9 (16.4) | 0.12 | |
5 Seems to ignore the urge to urinate | B versus Gc
| 0.006*
| ||||
boys | 482 (56.4) | 227 (59.0) | 234 (56.5) | 21 (37.5) | 0.010* | |
girls | 445 (49.8) | 180 (52.2) | 239 (48.5) | 26 (47.3) | 0.53 | |
6 Uses tricks to stay dry, like wriggling or forcefully crossing legs | B versus Gc
| 0.76 | ||||
boys | 295 (34.5) | 147 (38.2) | 136 (32.9) | 12 (21.4) | 0.030* | |
girls | 302 (33.8) | 114 (33.0) | 167 (33.9) | 21 (38.2) | 0.76 | |
7 Experiences a sudden uncontrollable urge to urinate | B versus Gc
| 0.04*
| ||||
boys | 505 (59.1) | 232 (60.3) | 244 (58.9) | 27 (48.2) | 0.48 | |
girls | 484 (54.2) | 190 (55.1) | 266 (54.0) | 28 (50.9) | 0.84 | |
8 Postpones first urination in the morning | B versus Gc
| 0.09 | ||||
boys | 231 (27.0) | 105 (27.3) | 112 (27.1) | 14 (25.0) | 0.94 | |
girls | 274 (30.7) | 98 (28.4) | 156 (31.6) | 20 (36.4) | 0.39 | |
9 Wets the bed or diaper during sleeping periods | B versus Gc
| <0.001*
| ||||
boys | 445 (52.0) | 210 (54.5) | 208 (46.7) | 29 (48.2) | 0.40 | |
girls | 297 (33.3) | 129 (37.4) | 154 (31.2) | 14 (25.5) | 0.079 | |
10 Wakes up at night to urinate | B versus Gc
| 0.01*
| ||||
boys | 151 (17.7) | 56 (14.5) | 87 (21.0) | 8 (14.3) | 0.045* | |
girls | 202 (22.6) | 72 (20.9) | 116 (23.5) | 14 (25.5) | 0.58 | |
11 Has two or fewer bowel movements per week | B versus Gc
| 0.44 | ||||
boys | 176 (20.6) | 77 (20.0) | 85 (20.5) | 14 (25.0) | 0.014* | |
girls | 197 (22.1) | 92 (26.7) | 91 (18.5) | 14 (25.5) | 0.69 | |
12 Stains or soils the underwear with stools | B versus Gc
| 0.001*
| ||||
boys | 440 (51.5) | 183 (47.5) | 202 (48.8) | 30 (53.6) | 0.69 | |
girls | 363 (40.6) | 152 (44.1) | 183 (37.1) | 28 (50.9) | 0.037* | |
13 Has hard stools or painful bowel movements | B versus Gc
| <0.001*
| ||||
boys | 164 (19.2) | 58 (15.1) | 91 (22.0) | 15 (26.8) | 0.015* | |
girls | 250 (28.0) | 92 (26.7) | 141 (28.6) | 17 (30.9) | 0.73 | |
14 Has large amounts of stool (that may obstruct the toilet) | B versus Gc
| 0.57 | ||||
boys | 164 (19.2) | 65 (16.9) | 84 (20.3) | 15 (26.8) | 0.16 | |
girls | 181 (20.3) | 82 (23.8) | 84 (17.0) | 15 (23.7) | 0.024* | |
15 Postpones bowel movements | B versus Gc
| <0.001*
| ||||
boys | 337 (39.4) | 172 (44.7) | 150 (36.2) | 15 (26.8) | 0.021* | |
girls | 279 (31.2) | 120 (34.8) | 136 (27.6) | 23 (41.8) | 0.002* | |
16 Experiences a sudden uncontrollable urge to defecate | B versus Gc
| 0.06 | ||||
boys | 402 (47.0) | 187 (48.6) | 192 (46.4) | 23 (41.1) | 0.54 | |
girls | 361 (40.5) | 139 (40.3) | 197 (40.0) | 25 (46.3) | 0.66 | |
17 Has abdominal pain | B versus Gc
| <0.001*
| ||||
boys | 299 (35.0) | 128 (33.3) | 150(36.2) | 21 (37.5) | 0.22 | |
girls | 400 (44.9) | 142 (41.3) | 233 (47.5) | 25 (45.5) | 0.64 | |
18 Has a bloated belly | B versus Gc
| <0.001*
| ||||
boys | 162 (18.9) | 67 (17.1) | 77 (18.6) | 18 (32.1) | 0.030* | |
girls | 253 (28.3) | 90 (26.1) | 137 (27.8) | 26 (47.3) | 0.005* | |
At least one bladder symptom | B versus Gc
| 0.27 | ||||
boys | 773 (90.4) | 355 (92.2) | 371 (89.6) | 47 (83.9) | 0.11 | |
girls | 793 (88.8) | 313 (90.7) | 493 (88.0) | 46 (83.6) | 0.22 | |
At least one bowel symptom | B versus Gc
| 0.93 | ||||
boys | 686 (80.2) | 312 (81.0) | 331 (80.0) | 43 (76.8) | 0.74 | |
girls | 718 (80.4) | 227 (80.3) | 391 (79.3) | 50 (90.9) | 0.12 | |
Combined bladder and bowel symptom | B versus Gc
| 0.61 | ||||
boys | 624 (73.0) | 286 (74.3) | 300 (72.5) | 38 (67.9) | 0.57 | |
girls | 642 (71.9) | 253 (73.3) | 347 (70.4) | 42 (76.4) | 0.48 |
Locomotor problems
Total | 1-HC | 2-HC | 3-HC |
P valuea
| |
---|---|---|---|---|---|
n = 1674 |
n = 684 |
n = 881 |
n = 109 | ||
Motor learning | |||||
Reduced manual dexterityb
| 175 (10.5) | 73 (10.7) | 88 (10.0) | 14 (12.8) | 0.64 |
Problems of motor skillsc
| 286 (17.1) | 99 (14.6) | 164 (19.0) | 23 (21.3) | 0.041*
|
Problems starting and performing a taskc
| 266 (15.9) | 101 (14.8) | 145 (16.5) | 20 (18.5) | 0.50 |
Motor control | |||||
Problems in core stabilityc
| 154 (9.2) | 51 (7.5) | 86 (9.8) | 17 (15.7) | 0.015*
|
Musculoskeletal | |||||
Increased muscle tension | 180 (10.8) | 76 (12.1) | 94 (11.3) | 10 (10.1) | 0.83 |
Reduced muscle tension | 28 (1.7) | 13 (1.8) | 13 (1.4) | 2 (1.8) | 0.91 |