Constipation and Lower Urinary Tract Dysfunction in Children and Adolescents: A Population-Based Study.

OBJECTIVE: To evaluate the correlation between constipation and lower urinary tract dysfunction (LUTD) and nocturnal enuresis in a population-based study. MATERIAL AND METHODS: This is a cross-sectional study. The criteria for inclusion were children and adolescents of between 5 and 17 years and who agreed to sign the informed consent form. The study excluded students with neurological problems or who had documented abnormalities of the urinary tract. To identify the presence and severity of LUTD, we used the Voiding Dysfunction Symptom Score (DVSS). To evaluate the presence of constipation, Rome III questionnaire was used. RESULTS: We interviewed 829 children and adolescents, of which 416 (50.18%) were male. The mean (SD) age was 9.1 (±2.9) years. The overall prevalence of LUTD was 9.1%, predominantly in girls (15 versus 3.1%, p < 0.001). Constipation was found in 9.4% of boys and 12.4% of girls (p = 0.169). Constipated children were 6.8 times more likely to have LUTD than those not constipated (p < 0.001, coefficient and correlation of 0.411). Constipation was found in 8.2% of children without LUTD and in 35.2% of children with LUTD. We performed multivariate analysis to identify urinary symptoms that are independent predictors of the presence of constipation. The presence of infrequent urination (p = 0.004) and holding maneuvers (p < 0.001) were independent predictors. It was noted also noted that constipated children, according to the Rome III criteria, possess a worse DVSS (p < 0.001). Regarding the presence of nocturnal enuresis, 12.6% of children and adolescents had constipation in association with this symptom. However, this relationship was not statistically significant (p = 0.483). CONCLUSION: Constipated children were 6.8 times more likely to have LUTD than those not constipated. Among the urinary symptoms, infrequent voiding and holding maneuvers are independent factors of urinary expressions in constipated children. Children with more severe constipation have more prominent urinary symptoms. The presence of enuresis was not associated with constipation.

Enuresis and overactive bladder in children: what is the relationship between these two conditions?

OBJECTIVE: Evaluate clinical aspects associated with the presence of nocturnal enuresis (NE) in children with a diagnosis of overactive bladder (OAB). MATERIAL AND METHODS: A data base of 200 children who were evaluated by a structured questionnaire was analysed retrospectively . OAB was defined as the presence of urinary urgency (n=183 cases) and/or daytime urinary incontinence associated with holding maneuvers (n=168 cases). Inclusion criteria were a confirmed diagnosis of OAB, age 5-16 years, and no anatomical or neurological alterations of the urinary tract. Patients were divided into enuretics and non-enuretics. The two groups were compared with respect to sex, age, skin color, presence urinary infection, urgency, urge incontinence, non-urge incontinence, pollakiuria, urinary dysfunction, nocturia, holding maneuvers, number of episodes of enuresis and bowel alterations. In a univariate analysis, the chi-square test was used to compare proportions, with p-values <0.05 being considered significant. A multivariate analysis was conducted to identify independent predictive factors. RESULTS: Enuresis was diagnosed in 141/200 children. The two groups were similar with respect to sex, age and skin color. No difference was found in relation to urinary infection, non-urge incontinence, urinary dysfunction, nocturia, encopresis or constipation. The two groups were significantly different with regard to some symptoms related to OAB such as urgency (p=0.001), urge incontinency (p=0.001) and holding maneuvers (p=0.033). Following multivariate analysis, only holding maneuvers (p=0.022) remained as an independent predictive factor. CONCLUSION: The only independent predictive factor for resolution of enuresis in children with OAB, as detected in the multivariate analysis, was holding maneuvers.

Enuresis and overactive bladder in children: what is the relationship between these two conditions?

ABSTRACT Objective: Evaluate clinical aspects associated with the presence of nocturnal enuresis (NE) in children with a diagnosis of overactive bladder (OAB). Material and Methods: A data base of 200 children who were evaluated by a structured questionnaire was analysed retrospectively . OAB was defined as the presence of urinary urgency (n=183 cases) and/or daytime urinary incontinence associated with holding maneuvers (n=168 cases). Inclusion criteria were a confirmed diagnosis of OAB, age 5-16 years, and no anatomical or neurological alterations of the urinary tract. Patients were divided into enuretics and non-enuretics. The two groups were compared with respect to sex, age, skin color, presence urinary infection, urgency, urge incontinence, non-urge incontinence, pollakiuria, urinary dysfunction, nocturia, holding maneuvers, number of episodes of enuresis and bowel alterations. In a univariate analysis, the chi-square test was used to compare proportions, with p-values <0.05 being considered significant. A multivariate analysis was conducted to identify independent predictive factors. Results: Enuresis was diagnosed in 141/200 children. The two groups were similar with respect to sex, age and skin color. No difference was found in relation to urinary infection, non-urge incontinence, urinary dysfunction, nocturia, encopresis or constipation. The two groups were significantly different with regard to some symptoms related to OAB such as urgency (p=0.001), urge incontinency (p=0.001) and holding maneuvers (p=0.033). Following multivariate analysis, only holding maneuvers (p=0.022) remained as an independent predictive factor. Conclusion: The only independent predictive factor for resolution of enuresis in children with OAB, as detected in the multivariate analysis, was holding maneuvers.

Parasacral transcutaneous electrical stimulation for overactive bladder in children: An assessment per session.

OBJECTIVE: Neuromodulation has emerged as an effective therapeutic option for treatment of OAB in children. However, to our knowledge, no study has yet evaluated the results of neuromodulation on a session-by-session basis. The aim of this study was to evaluate the rate of complete response of overactive bladder (OAB) symptoms for each session of transcutaneous electrical stimulation (TENS), in a protocol of 20 sessions of therapy. METHOD: This is a prospective study of the improvement of LUTS in children with isolated OAB. Included in this study were children over the age of 4 years who complained of urinary urgency, had bell-or tower-shaped uroflowmetry patterns, and post-void residual <10% of expected capacity for their age and/or less than 20 mL. No patient was treated with an anticholinergic. Children were excluded with lower urinary tract symptoms (LUTS) secondary to urinary tract abnormalities. All patients underwent parasacral transcutaneous neurostimulation (TENS). The development of symptoms was observed right before each session using a visual analog scale (VAS) in which 0 means the absence of improvement and 10 represents maximum improvement of symptoms. RESULTS: We noted a complete resolution of symptoms (urgency, urge incontinence, frequency, and holding maneuvers) in some patients starting after the third session. In the 10th and 20th (last) sessions, 12 (17.4%) and 38 (55.1%) patients reported a complete resolution of symptoms. After complete resolution, 12 (17.4%) patients reported that their symptoms worsened to a minimum level of 40% improvement, but this was temporary and all returned to 100% improvement. Children who showed an improvement level greater than 50% in the fifth treatment session were 4.18 (p = 0.007) times more likely to have success in the last treatment session. CONCLUSION: We found that a patient can experience complete symptom resolution as quickly as following the third session of TENS. The complete response rate progressively increases with the number of sessions, slowly until the 12th session and more rapidly after that. When symptom improvement of at least 50% is reported in the fifth session, there is a higher chance that the patient will have full resolution of symptoms at the end of treatment.