Elsevier

Journal of Pediatric Urology

Volume 12, Issue 2, April 2016, Pages 109.e1-109.e6
Journal of Pediatric Urology

Non-biological determinants of paediatric bladder bowel dysfunction: A pilot study

https://doi.org/10.1016/j.jpurol.2015.09.006Get rights and content

Summary

Objectives

Children with bladder and bowel dysfunction (BBD) constitute a significant proportion of referrals at paediatric urology clinics worldwide, presenting with a wide range of symptom severity that may significantly affect quality of life. Non-biological factors may play a key role in triggering BBD severity, but these underpinning causes of BBD during childhood are still unknown. The aim of this study was to identify the effects of personal, family related and environmental variables on the severity of BBD symptoms in school-aged children.

Study design

A pilot, prospective, observational study was conducted on 53 children diagnosed with BBD, and their legal guardian(s), on their first referred visit to a paediatric BBD clinic led by nurse practitioners. Upon receiving consent, patients and their legal guardian(s) completed three study questionnaires, with the guidance of research coordinators. The first questionnaire was the Dysfunctional Voiding Scoring System (DVSS); the second, a three-part questionnaire used to collect demographic information and data on the patient, their family and environmental characteristics; and the third gathered a detailed history of the child's lifestyle regimen, focusing on their bowel and bladder function.

Results

Most of the children were female (66%), with an average age of 8.35 years. Most children attended public schools (74%) and none reported failing a grade. The mean parental age was 41.4 years (SD = 4.9 years), 62% of the families had two children and 53% were Caucasian. The mean DVSS score for this sample was 9.9 (SD = 4.2, range 2–21). Daycare attendance, school problems and unplanned pregnancy showed statistically significant influences on the severity of BBD and were associated with higher DVSS scores according to the Table below.

Conclusions

Children with BBD attending urology outpatient clinics as new referrals had more severe symptoms when they were born from an unplanned pregnancy, attended daycare and/or had school problems. These findings suggest that interventions aimed at decreasing BBD severity, or preventing its onset in school-aged children, should focus on the environment surrounding them, specifically on the interaction between personal, familial and environmental factors. These factors seem to have an important effect on paediatric continence, as children grow and develop under numerous societal influences and social interactions.

Table. Multiple regression models: significant statistical variables and their impact on mean Dysfunctional Voiding Scoring System score.

ModelsCoefficientstMultivariate P
Multiple regression (personal variables)
Intercept6.607.62<0.001
Did your child ever have problems at school? (yes)3.303.180.003
Has your child gone to daycare? (yes)3.002.950.005
R2 = 0.26
Multiple regression (family related variables)
Intercept11.9311.45<0.001
Was your pregnancy planned? (yes)−2.88−2.340.02
R2 = 0.08

Note: Only P-values <0.05 are shown.

R2, determination coefficient.

Introduction

Children with bladder and bowel dysfunction (BBD) constitute a significant proportion of referrals at paediatric urology clinics worldwide [1], [2]. The International Children's Continence Society (ICCS) recommends using the term BBD to describe this combined bladder and bowel disturbance [3]. Children with urinary and associated bowel problems have symptoms that significantly affect their quality of life, particularly academic, social and emotional aspects of childhood [4], [5].

Since there is evidence that personal, family related and environmental risk factors influence continence acquisition during childhood [6], [7], it is reasonable to extrapolate that these factors can affect the severity of BBD. Few studies have systematically addressed the impact of these aggregated factors on BBD development and its severity for children referred to paediatric urologic clinics [5], [8], [9]. It was hypothesised that non-traditional factors pertaining to the child, his/her family and environment may influence the severity of BBD.

Section snippets

Study design, setting and subjects

After obtaining approval by the Research Ethics Board (REB # 1000044683) at a paediatric tertiary hospital, a pilot, prospective, observational study was conducted between April and August 2014 in a clinic led by nurse practitioners. The present study analysed a consecutive cohort of 53 newly referred patients aged 6–12 years, and their legal guardian(s), after a diagnosis of BBD, as defined by the ICCS [3]. The 53 newly referred patients were not under any urotherapy or urological medications

Results

Of the 151 patients who were screened, 98 were not enrolled in the study: 49 were not included based on the exclusion criteria (age, anomalies and refusal of a full physical exam) and an additional 49 patients were eligible, but were not included for several reasons (33 declined to take part in the study, two could not be reached by the researchers, and 14 missed their clinic appointment). Of the 53 enrolled patients, 35 (66%) were girls and 18 (34%) were boys, with a mean and median age of

Discussion

The main findings obtained from the present study showed that children with BBD attending urology outpatient clinics as new referrals had more severe symptoms when they were born from an unplanned pregnancy, attended daycare and/or had school problems.

It was noted that the sample had a wide variation of DVSS (from 2 to 21 points), with a mean score of 9.9 (above the clinical threshold score for dysfunctional voiding). Some children scored below the threshold DVSS values because they presented

Conclusion

Children with BBD attending urology outpatient clinics as new referrals had more severe symptoms when they were born from an unplanned pregnancy, attended daycare and/or had school difficulties. These significant associations highlight the importance of acting on a combination of individual, family, community and environmental factors to prevent the onset or minimise the severity of BBD.

Nevertheless, further studies are needed to investigate these influences and confirm the significance of

Conflict of interest

Nil.

Funding

Nil.

Acknowledgements

Thank you to Mrs Theresa Thompson for her valuable support with the Research Ethics Board's application, at Sick Kids Hospital®. Thank you also to the Nurse Practitioner Dilshad Kassam-Lallani for her assistance during patient recruitment.

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