Neurodevelopmental and psychiatric disorders in pediatric bladder and bowel dysfunction

Rebecca Wang; Meta Van den Heuvel; Mandy Rickard; Yara El-Bardisi; Niraj Mistry; Martin Koyle; Walid Farhat; Joana Dos Santos

doi:10.1016/j.jpurol.2021.03.032

Neurodevelopmental and psychiatric disorders in pediatric bladder and bowel dysfunction

J Pediatr Urol. 2021 Aug;17(4):450.e1-450.e6. doi: 10.1016/j.jpurol.2021.03.032. Epub 2021 Apr 3.

Authors

Rebecca Wang¹, Meta Van den Heuvel², Mandy Rickard³, Yara El-Bardisi⁴, Niraj Mistry², Martin Koyle³, Walid Farhat⁵, Joana Dos Santos⁶

Affiliations

¹ Department of Pediatrics, Hospital for Sick Children, University of Toronto, Ontario, Canada; Faculty of Art & Science, University of Toronto, Ontario, Canada.
² Department of Pediatrics, Hospital for Sick Children, University of Toronto, Ontario, Canada.
³ Division of Urology, Hospital for Sick Children and Department of Surgery, University of Toronto, Ontario, Canada.
⁴ Faculty of Art & Science, University of Toronto, Ontario, Canada.
⁵ Division of Pediatric Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
⁶ Division of Urology, Hospital for Sick Children and Department of Surgery, University of Toronto, Ontario, Canada. Electronic address: joana.dossantos@sickkids.ca.

PMID: 33947637
DOI: 10.1016/j.jpurol.2021.03.032

Abstract

Background: Bladder and bowel dysfunction (BBD) is a common pediatric problem that describes a constellation of lower urinary tract symptoms associated with constipation and/or encopresis. Its association with neurodevelopmental and psychiatric (NDP) problems is not well understood.

Objectives: Our primary aim was to identify pre-existing NDP disorders in children with BBD. Secondarily, we aimed to screen for new behavioral problems and evaluate the association between bladder or bowel symptoms and behaviors symptoms.

Methods: A cross sectional study was conducted in urology clinics. New patients referred for BBD between 4 and 17 years old were recruited and completed: a demographics survey, Dysfunctional Voiding Score System questionnaire, assessment of bowel movements with the Bristol Stool Scale, and Strength and Difficulties questionnaire (SDQ). Those with known spinal dysraphism were excluded. SDQ scores were evaluated for abnormal screens in different subscales and total difficulties scores. Pearson correlation analyses were conducted for association.

Results: We included 61 participants (age 9.5 ± 4.1 years), including 33 females and 28 males. One or more pre-existing NDP disorder(s) was reported in 14 (23%) children; most commonly being learning disability (43%) and attention deficit hyperactivity disorder (29%). This cohort had more severe BBD symptoms as reflected in DVSS scores. SDQ scores demonstrated that 12 patients without pre-existing NDP diagnoses scored in the clinical range, with hyperactivity as the most common difficulty (6/12; 50%).

Conclusions: A significant proportion of children with BBD have a comorbid NDP disorder and present with more severe symptomatology. The SDQ can be used as a behavioral screening tool this population for the identification of children who may benefit from formal developmental pediatrics assessment.

Keywords: Behavioral symptoms; Bladder and bowel dysfunction; Lower urinary tract symptoms; Neurodevelopment disorders.

MeSH terms

Adolescent
Attention Deficit Disorder with Hyperactivity*
Child
Child, Preschool
Constipation / diagnosis
Constipation / epidemiology
Cross-Sectional Studies
Female
Humans
Male
Pediatrics*
Surveys and Questionnaires
Urinary Bladder