Voiding disorders in severely mentally and motor disabled children

We evaluated the voiding and continence patterns in severely mentally and motor disabled children.

The hetero-anamnestic, uroflometer and morning urine concentration profile results of 17 girls and 21 boys with severe mental and motor disability were evaluated in a prospective study.

Of the children 20 (52.7%) suffered daytime and/or nighttime wetting and 18 (47.4%) were continent. Daytime and nighttime wetting occurred in 85.7% of children with tetraparesis and in 66.6% of those with an IQ between 46 and 55, representing the highest incidence rates. Bladder capacity was too small for age (mean deficit 145 ml.) in 92% of the children. Uroflowmetry demonstrated a dysfunctional pattern in 60.7% of patients. Dysfunctional voiding occurred in 100% of children with coordination disorders and in 87.5% of those with an IQ between 46 and 55, representing the highest incidence rates. The morning urine concentration profiles showed an osmolality of at least 1,021 mOsm./kg. in all cases.

Although we found a remarkably high incidence of dysfunctional voiding, no correlation between the uroflow and continence patterns could be found. Restricted fluid intake, due to swallowing problems and insufficient hydration, causes an important bladder capacity deficit in most patients. Becoming continent is determined by motor disability, especially the degree of mobility, rather than by mental development.