Systematic review of the relationship between bladder and bowel function: implications for patient management

Kaplan, Steven A.; Dmochowski, Roger R.; Cash, Brooks D.; Kopp, Zoë; Berriman, Sandra; Khullar, Vik

doi:10.1111/ijcp.12028

Cited by 71 publications

(60 citation statements)

References 72 publications

(101 reference statements)

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“…It is commonly associated with vesicoureteral reflux (VUR) and recurrent urinary tract infections (UTIs), which ultimately may lead to renal scarring and kidney failure. [1][2][3][4] BBD negatively affects children's quality of life and self-esteeml; therefore, early diagnosis and treatment of BBD are critical to avoid secondary comorbidities that can adversely impact children's kidney and bladder function, as well as their psychosocial well-being.…”

Section: Introductionmentioning

confidence: 99%

Bladder and bowel dysfunction in children: An update on the diagnosis and treatment of a common, but underdiagnosed pediatric problem

Santos

Lopes

Koyle

2017

CUAJ

138

126

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Bladder and bowel dysfunction (BBD) describes a spectrum of lower urinary symptoms (LUTS) accompanied by fecal elimination issues that manifest primarily by constipation and/or encopresis. This increasingly common entity is a potential cause of significant physical and psychosocial burden for children and families. BBD is commonly associated with vesicoureteral reflux (VUR) and recurrent urinary tract infections (UTIs), which at its extreme may lead to renal scarring and kidney failure. Additionally, BBD is frequently seen in children diagnosed with behavioural and neuropsychiatric disorders such as attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Patients with concomitant BBD and neuropsychiatric disorders have less favourable treatment outcomes. Early diagnosis and treatment of BBD are critical to avoid secondary comorbidities that can adversely impact children's kidney and bladder function, and psychosocial well-being. The majority of patients will improve with urotherapy, adequate fluid intake, and constipation treatment. Pharmacological treatment must only be considered if no improvement occurs after intensive adherence to at least six months of urotherapy ± biofeedback and constipation treatment. Anticholinergics remain the mainstay of medical treatment. Selective alpha-blockers appear to be effective for improving bladder emptying in children with non-neurogenic detrusor overactivity (DO), incontinence, recurrent UTIs, and increased post-void residual (PVR) urine volumes. Alpha-1 blockers can also be used in combination with anticholinergics when overactive bladder (OAB) coexists with functional bladder outlet obstruction. Minimally invasive treatment with onabotulinumtoxinA bladder injections, and recently neurostimulation, are promising alternatives for the management of BBD refractory to behavioural and pharmacological treatment.In this review, we discuss clinical presentation, diagnostic approach, and indications for behavioural, pharmacological, and surgical treatment of BBD in children based on a thorough literature review. Expert opinion will be used when scientific evidence is unavailable.

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Section: Introductionmentioning

confidence: 99%

Bladder and bowel dysfunction in children: An update on the diagnosis and treatment of a common, but underdiagnosed pediatric problem

Santos

Lopes

Koyle

2017

CUAJ

138

126

View full text Add to dashboard Cite

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“…Crosstalk between neural pathways in the pelvic organs is necessary for the routine mediation of bladder, bowel, and sexual function. 27, 28 This crosstalk also provides a pathway for abnormal function of these organs, with the potential for dysfunction of one pelvic organ leading to functional changes in another organ system. The results of this study support this theory of increasing frequency of bowel dysfunction (specifically constipation) in men with UI.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Characteristics of Urinary Incontinence in a Treatment Seeking Male Prospective Cohort: Results from the LURN Study

et al. 2018

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Purpose: Male urinary incontinence (UI) is thought to be infrequent. We sought to describe the prevalence of UI in a male treatment-seeking cohort enrolled in the Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN). Materials and Methods: The inclusion/exclusion criteria, including men with prostate cancer or a neurogenic bladder, have been previously reported. LURN participants prospectively completed questionnaires regarding lower urinary tract symptoms (LUTS) and other clinical variables. Men were grouped based on type of incontinence (1=non-UI; 2=post-void dribbling [PVD] only; 3=UI). Comparisons were made using analysis of variance and multivariable regression. Results: Among 477 men, 24% reported non-UI, 44% PVD only, and 32% UI. Black men and those with sleep apnea were more likely to be in the UI group compared with the non-UI group (odds ratio [OR]=3.2, p=0.02 and OR=2.73, p=0.003, respectively). UI was associated with significantly (p<0.001) higher bother compared to those without leakage. Compared to men without UI and men with PVD only, men with UI were significantly (p<0.01) more likely to report higher scores (more severe symptoms) on patient-reported outcomes measurement information system (PROMIS) questionnaires regarding bowel issues, depression, and anxiety, compared to those without UI. Conclusions: UI is common among treatment-seeking men. This is concerning because the guideline-recommended questionnaires for assessing male LUTS do not query for UI. Thus, clinicians may be missing an opportunity to intervene and improve patient care. This provides a substantial rationale for a new or updated symptom questionnaire that provides a more comprehensive symptom assessment.

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“…24,25 However, only a small percent of respondents reported having had experience with bowel incontinence. We theorize that because bowel dysfunction presents as constipation in up to 30% of the pediatric population, it is not as easily recognized in the school setting other than through its manifestation as urinary symptoms 26 .…”

Section: Discussionmentioning

confidence: 99%

Lower Urinary Tract Dysfunction in Elementary School Children: Results of a Cross-Sectional Teacher Survey

Chuang

Champeau

et al. 2016

Journal of Urology

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Purpose Lower urinary tract dysfunction in school-aged children is common and yet data are lacking on current teacher practice regarding bathroom use and daytime incontinence during classroom hours. We determined the prevalence of elementary school teachers who promote lower urinary tract health and identified predictors for and against such behavioral promotion. Materials and Methods We performed an electronic cross-sectional survey among self-identified teachers using targeted social media advertisement during a 1-week period in July 2014. The empirical survey tool consisted of 27 questions and collected data on 5 principal domains, including 1) teacher demographics, 2) rules and regulations on water intake and bathroom use during classroom hours, 3) characteristics of school bathrooms in terms of safety, supervision and suitability for use, 4) experience with and management of students with daytime incontinence and 5) training on the topic of lower urinary tract health. Predictors for promoting lower urinary tract health were identified by multivariable logistic regression. Results Of the 4,166 teachers who completed the survey 88% indicated that they encourage students to hold urine. Despite strict bathroom protocols 81% of teachers allowed children unlimited access to water. Of the teachers 82% reported never having undergone any professional development on bathroom regulations for children. Overall only 24% of surveyed teachers met criteria for promoting lower urinary tract health. The odds of promoting lower urinary tract health decreased with ascending grade level (OR 0.80, 95% CI 0.76–0.84). Conversely it increased if teaching experience was greater than 5 years (OR 1.66, 95% CI 1.39–1.98) or professional development on the subject had been received (OR 1.42, 95% CI 1.18–1.70). Conclusions Of elementary school teachers 76% are not promoting lower urinary tract health in school-aged children. Professional development training on the topics of lower urinary tract dysfunction and/or lower urinary tract health may be beneficial, particularly for educators who teach higher grades and those with less teaching experience.

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Systematic review of the relationship between bladder and bowel function: implications for patient management

Abstract: The relationship between bladder and bowel function should be considered when treating patients with urinary symptoms, bowel symptoms, or both.

Cited by 71 publications

References 72 publications

Bladder and bowel dysfunction in children: An update on the diagnosis and treatment of a common, but underdiagnosed pediatric problem

Bladder and bowel dysfunction in children: An update on the diagnosis and treatment of a common, but underdiagnosed pediatric problem

Prevalence and Characteristics of Urinary Incontinence in a Treatment Seeking Male Prospective Cohort: Results from the LURN Study

Lower Urinary Tract Dysfunction in Elementary School Children: Results of a Cross-Sectional Teacher Survey

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