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Urge incontinence and voiding postponement in children: somatic and psychosocial factors
B Lettgen1, A von Gontard, H Olbing
1Darmstädter Kinderklinik Prinzessin Margaret, Darmstadt, Germany. bernhard.lettgen@kinderkliniken.de
Insights
Daytime wetting in children is linked to behavioral issues and family dynamics. Voiding postponement is associated with more behavioral symptoms and less balanced family function compared to urge incontinence.
Area of Science:
- Pediatric Urology
- Child Psychiatry
- Behavioral Science
Background:
- Daytime wetting in children presents diagnostic challenges, often involving complex behavioral and familial factors.
- Understanding the distinct characteristics of different wetting syndromes is crucial for effective intervention.
Purpose of the Study:
- To compare urinary tract infections (UTIs), uroflowmetry, behavioral symptoms, and family interactions in children with daytime wetting.
- To differentiate between voiding postponement and urge incontinence based on clinical and familial parameters.
Main Methods:
- Prospective analysis of 94 children with voiding postponement or urge incontinence.
- Assessment included urinary tract infection history, uroflowmetry, Child Behaviour Checklist (CBCL), and Family Adaptability and Cohesion Evaluation Scales (FACES-III).
Main Results:
- Urge incontinence cases showed higher UTI rates (50%) than voiding postponement (19.2%).
- Voiding postponement was linked to abnormal uroflowmetry curves and a higher prevalence of behavioral symptoms (conduct, attention problems).
- Families of children with voiding postponement exhibited less balanced intrafamilial functioning.
Conclusions:
- Urge incontinence is associated with more UTIs, lower urine volume, fewer behavioral issues, and well-functioning families.
- Voiding postponement is characterized by behavioral symptoms, particularly conduct problems, and disrupted family dynamics, supporting its classification as a behavioral syndrome.
Aim:
To analyse the number of urinary tract infections, uroflowmetry, behavioural symptoms and intrafamilial interaction in two groups of daytime wetting children in a paediatric and a child psychiatric unit.
Methods:
Ninety-four children with either voiding postponement (52) or urge incontinence (42) were examined prospectively for history of urinary tract infections (UTIs), uroflowmetry, the syndrome scales of the Child Behaviour Checklist (CBCL 4/18-Achenbach) and the Family Adaptability and Cohesion Evaluation Scales (FACES-III) (Olson) questionnaire.
Results:
Children with urge incontinence had a significantly higher rate of previous urinary tract infections (50%) than children with voiding postponement (19.2%; p < 0.001), who showed a high rate of plateau (12.2%) and staccato (20.4%) curves and were characterized by a wide variety of behavioural symptoms, including withdrawn (11.6%), aggressive (11.8%), delinquent (19.6%) behaviour and attention problems (13.7%). Clinically relevant behavioural scores were 4-10 times higher for the voiding postponers, and 2-3 times higher for children with urge incontinence. Furthermore, families of voiding postponers had significantly fewer balanced types of intrafamilial function (FACES-III). Problematic "rigid/disengaged" and "rigid/separated" types predominated.
Conclusion:
Urge incontinence is characterized by a higher rate of UTIs, a lower urine volume in uroflowmetry, a lower rate of behavioural scores in the clinical range and well-functioning families. Voiding postponement children, on the other hand, have a higher, though not significant, rate of abnormal uroflow curves, a wide variety of clinically relevant behavioural symptoms, which were significantly higher for attention and delinquent problems. Conduct problems predominated; only 13.7% of the children had attention problems in the clinical range. The findings lend empirical support to the entity of voiding postponement as an acquired or behavioural syndrome characterized by wetting in association with a delay of micturition and other externalizing conduct problems.
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