Geneva Switzerland, 9 may – 12 may 2018

Bladder problems in children with functional defaecation disorders: a systematic review

J. J.G.T. van Summeren, MSC, G. A. Holtman, PhD, S.C. van Ommeren, BSC,  B. J. Kollen, PhD, J. H. Dekker, MD, PhD, M. Y. Berger, MD, PhD

Affiliations: University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly care medicine, The Netherlands

Abstract

Objectives and study: Bladder problems, like lower urinary tract symptoms (LUTS) and urinary tract infections (UTI) are often reported in children with functional defaecation disorders. The extent of the problem is unknown. The international Children’s Continence Society has introduced the term Bladder and Bowel Dysfunction to emphasize the frequent combination of bladder and bowel problems. The aim of this study is to systematically review the prevalence of bladder problems in children with functional defaecation disorders and to compare this prevalence rate among children with and without functional defaecation disorders.

Methods: A literature search was conducted in Medline, Embase, PsycINFO and Cochrane library. Studies investigating the prevalence of bladder problems in children aged 4 to 17 years with functional defaecation disorders were identified. There was no language restriction. Two reviewers independently extracted data, and assessed study quality with a checklist for prevalence studies. Prevalence rates of bladder problems in children with FDD were extracted or calculated. Relative risks were calculated to compare the prevalence of bladder problems between children with and without FDD. Clinical heterogeneity between the individual studies was investigated in order to determine whether a pooled meta-analysis of the reported prevalence rates and relative risk would be appropriate and meaningful. 

Results: Among 23 studies of children with FDD, 22 reported the prevalence of LUTS (12,281 children) and 7 reported the prevalence of UTI (687 children). LUTS (combined symptoms), LUTS (individual symptoms), and UTI had prevalence rates of 37%–64%, 2%–47%, and 6%–53%, respectively. The relative risks were 1.24–6.73 for LUTS (20 comparison LUT symptoms) and 2.18–6.55 for UTI (2 comparison studies), but the 95% confidence intervals indicated non-significance in 6 and 2 studies, respectively. Due to clinical heterogeneity in definition of FDD, definition of LUTS, and clinical setting a meta-analysis of the reported prevalence and relative risks would be inappropriate and meaningless.

Conclusions: Bladder problems seem common in children with FDD, but the reported prevalence varies greatly. Comparison studies suggest that children with FDD are more likely to have bladder problems than children without FDD. We recommend that clinicians be aware of concomitant bladder problems in children presenting with FDD. Constipation management (by laxatives) and urotherapy are recommended for the treatment of combined non-neurogenic bladder and bowel dysfunction in children.

 

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