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Development of bladder control in mentally handicapped children
Homero Bruschini1, Ney Faria, Eliza Garcez
1Division of Urology, Paulista School of Medicine, Federal University of São Paulo, São Paulo, SP, Brazil. bruschi@attglobal.net
Insights
Bladder control issues are linked to the severity of mental handicap. Severe and profound intellectual disability often leads to persistent incontinence, while milder cases experience delayed bladder training.
Area of Science:
- Neuroscience
- Urology
- Developmental Pediatrics
Background:
- Intellectual disability can impact various developmental milestones, including bladder control.
- Understanding the relationship between cognitive impairment and continence is crucial for patient care and family guidance.
Purpose of the Study:
- To investigate the correlation between the degree of mental handicap and the development of bladder control.
- To assess the likelihood of achieving urinary continence in individuals with intellectual disabilities to inform future patient management.
Main Methods:
- A personal interview-based study involving parents and relatives of 100 mentally handicapped patients.
- Data collected included age of diaper cessation, enuretic events, urinary leakage, urgency, frequency, and urinary tract infections.
- Patient intellectual disability was categorized by grade (profound to mild) and etiology was recorded.
Main Results:
- All patients with profound and severe intellectual disability exhibited urinary leakage.
- Individuals with mild and borderline intellectual functioning showed progressive urinary control with age, though 33% had symptoms beyond 16 years.
- Urinary tract infection rates were similar across genders and lower in more severely affected groups; etiology did not correlate with leakage.
Conclusions:
- Lack of bladder control is significantly correlated with the grade of mental handicap.
- Continence outcomes are poor for individuals with severe and profound intellectual disabilities.
- Milder intellectual disability is associated with delayed bladder training, with two-thirds achieving control after age 16; those with borderline intelligence may achieve delayed control, potentially misdiagnosed.
Purpose:
To analyze the role of mental handicap as a possible source of lack of development of bladder control and to find out the chance of continence to advise future patients.
Materials And Methods:
The parents and relatives of 100 consecutive mentally handicapped patients were inquired by a personal interview. Questions included the age when they stopped using diapers, enuretic events, frequency, urgency and leakage episodes, urinary infections. Etiology of their mental problem was unknown in 34, perinatal anoxia in 17, Down syndrome in 15, phenylketonuria in 18 and others minors causes. The grade of mental deficiency were profound in 1, severe in 10, moderate in 39, mild in 33 and normal inferior value in 17. The age varied from 7 to 37 years old, with an average of 14 by the time of the interview, comprising 60 males and 40 females.
Results:
All profound and severe patients presented leakage episodes regardless of the age. The mild and normal inferior value acquired progressive urinary control with aging, and 33% still remain with urinary symptoms above 16 years old. Urinary infection was similar in males and females, around 29%. The most committed group presented less urinary infections. The etiology of the mental handicap was not correlated to the incidence of urinary leakage.
Conclusions:
The lack of bladder control was correlated to the grade of mental handicap. In severe and profound groups, the expectancy of control is disappointing. In the less compromised groups, there is a delay in bladder training, with achievement of control in (2/3) after 16 years of age. Those in the normal inferior value have a chance of postponed urinary control, easily misdiagnosed by normal urological interviews.
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