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