Behavioral comorbidity, overweight, and obesity in children with incontinence: An analysis of 1638 cases

Abstract

Aims Children with nocturnal enuresis (NE), daytime urinary incontinence (DUI), and fecal incontinence (FI) are at risk for behavioral problems, overweight, and obesity. The aim of this study was to analyze the specific behavioral and weight comorbidity in subtypes of incontinence. Methods A total of 1638 consecutive patients presented to a tertiary incontinence clinic from 2012 to 2018 was examined prospectively according to ICCS criteria. Behavioral symptoms were measured with the Child Behavior Checklist (CBCL). Psychiatric disorders were diagnosed according to ICD‐10 criteria. Weight categories were calculated according to WHO recommendations. Results The mean age was 7.8 years, 67% of patients were male. Fifty‐seven percent had NE (n = 934), 33% DUI (n = 547), and 40% FI (n = 656). Boys had significantly higher rates of NE and FI than girls. Of all children, 39.2% (n = 539) had a clinically relevant CBCL total score. A total of 28.3% (n = 463) had an ICD‐10 psychiatric diagnosis, mainly ODD and ADHD, and 28.6% (n = 463) were overweight or obese. Boys were more often affected by behavioral symptoms, psychiatric disorders, and overweight/obesity. Children with NE had the highest rate of overweight/obesity. Except for primary nonmonosymptomatic NE, subtypes of incontinence did not differ regarding behavioral symptoms and weight categories. However, overweight/obesity was significantly associated with behavioral and psychiatric parameters. Conclusions Behavioral symptoms and psychiatric disorders, as well as overweight/obesity are important risk factors associated with incontinence, but the interaction between these factors is complex. In clinical settings, all children with incontinence should be screened with behavioral questionnaires. Also, weight should be measured, and overweight/obesity should be addressed.

Emotional, Behavioral and Social Problems in Children with Fecal Incontinence by Child Behavior Checklist (CBCL): A Cross-sectional Study

“…The effect of psychological factors on the development and persistence of fecal incontinence is debatable. Nevertheless, incontinence in children and adolescents with neurodevelopmental and psychological disorders is common and vice versa (8,9). Treating incontinence can reduce the severity of psychological disor-ders (7).…”

Association Between Obesity and Lower Urinary Tract Symptoms Among Children and Adolescents: A Community-Based Study

“…The study by Wagner et al (23) also concluded that being overweight or obese gives you a significant higher risk of developing OAB symptoms, especially urinary incontinence (p = 0.017). A recent study by von Gontard et al (24) supported the theory that behavioral symptoms, psychiatric disorders, and being overweight/obese were risk factors associated with urinary incontinence. However, we did not observe a significantly higher risk of daytime incontinence in obese children and adolescents in the current study.…”

Childhood Obesity: Position Statement of Polish Society of Pediatrics, Polish Society for Pediatric Obesity, Polish Society of Pediatric Endocrinology and Diabetes, the College of Family Physicians in Poland and Polish Association for Study on Obesity

“…The obesity seems to be an important risk factor associated with incontinence, but the interaction between these factors is complex and needs further investigation [117].…”