Behavior Profiles in Children With Functional Urinary Incontinence Before and After Incontinence Treatment

Abstract

Since the 1980s, urinary incontinence and bed-wetting started to be seen as functional problems, with behavioral problems secondary to the bed-wetting. Behavioral problems in bed-wetting is studied extensively, but much less has been studied regarding behavioral problems in functional incontinence. What This Study AddsAbnormal behavior scores in children with functional incontinence were studied prospectively, before and after treatment for incontinence, as part of a randomized controlled trial. ABSTRACTOBJECTIVE. The purpose of this work was to analyze prospectively the prevalence of behavioral disorders in children with urinary incontinence because of nonneuropathic bladder-sphincter dysfunction before and after treatment for incontinence. METHODS.A total of 202 children with nonneuropathic bladder-sphincter dysfunction were enrolled in the European Bladder Dysfunction Study, in branches for urge syndrome (branch 1) and dysfunctional voiding (branch 2); 188 filled out Achenbach's Child Behavior Checklist before treatment and 111 after treatment. Child Behavior Checklist scales for total behavior problems were used along with subscales for externalizing problems and internalizing problems.RESULTS. After European Bladder Dysfunction Study treatment, the total behavior problem score dropped from 19% to 11%, the same prevalence as in the normative population; in branch 1 the score dropped from 14% to 13%, and in branch 2 it dropped from 23% to 8%. The prevalence of externalizing problems dropped too, from 12% to 8%: in branch 1 it was unchanged at 10%, and in branch 2 it dropped from 14% to 7%. The decrease in prevalence of internalizing problems after treatment, from 16% to 14%, was not significant.CONCLUSION. More behavioral problems were found in dysfunctional voiding than in urge syndrome, but none of the abnormal scores related to the outcome of European Bladder Dysfunction Study treatment for incontinence. With such treatment, both the total behavior problem score and the score for externalizing problems returned to normal, but the score for internalizing problems did not change. The drops in prevalence are statistically significant only in dysfunctional voiding. F UNCTIONAL URINARY INCONTINENCE is a leading symptom of both urge syndrome and dysfunctional voiding. These 2 clinical entities occur mainly in girls, 1-3 as manifestations of nonneuropathic bladder-sphincter dysfunction (NNBSD), and have always been associated with behavior problems; the International Classification of Diseases, 10th Revision, lists both "enuresis of nonorganic origin" and "urinary incontinence of nonorganic origin" in the category of mental and behavioral disorders. 4,5 For primary monosymptomatic nocturnal enuresis (MNE), this association has been studied quite extensively, [6][7][8][9][10][11][12] and in terms of temperament, emotional stress, and anxiety, most studies indicate that children with MNE are not different from those without. The only specific links between MNE and behavior problems belong to the domain of secondary...

Correlation between Lower Urinary Tract Scoring System, Behavior Check List, and Bladder Sonography in Children with Lower Urinary Tract Symptoms

“…Schast et al reported a higher mean score for the PLUTSS in children with ADHD or learning disabilities [15]. Bael et al found that the TCS and EXTS improved after therapy in children with dysfunctional voiding, but that the scores did not change for urge incontinence [16]. In contrast, our study showed that patients with both urge incontinency and voiding postponement had higher TCS, INTS, and EXTS than did controls.…”

Neuropsychiatric Disorders and Voiding Problems in Children

“…In a study by Bael et al [10] in 2008, they found that, before treatment of non-neurogenic bladder sphincter dysfunction (NNBSD) in the European bladder dysfunction group, behavioral problems were present in 19% of the children at a rate of 2:1 compared to normative population. After treatment of incontinence, the rate dropped to 11%, which was the same as the normative group.…”

Lower Urinary Tract Dysfunction: A Childhood Problem in Adults?

“…They also noted that fathers of children with OAB had resolution of nocturnal enuresis at a later age than controls. Mothers of children with OAB or DV also reported on their current symptoms using the Urogenital Distress Inventory and demonstrated that symptoms of OAB-but not DVpersisted into adulthood, further supporting the concept that DV is more influenced by behavioral components than OAB [48].…”