Adequate fluid intake, urinary incontinence, and physical and/or intellectual disability

Urinary incontinence in physically and/or intellectually disabled children is a common problem. Literature on therapy is sparse. In these patients we prospectively studied the effect of urotherapy, particularly adequate fluid intake.

In a prospective study 66 boys and 45 girls with a mean age of 9.1 years were included, of whom 22 were motor disabled, 16 were mentally disabled and 73 had mental and motor disability. All patients were put on a fluid intake schedule of 1,500 ml/m(2) body surface. Mean followup was 22.9 months (range 12 to 30). Patients were evaluated using a diary, uroflowmetry and bladder scan.

Of the children 44 (39.6%) were dry at study inclusion, 41 (46.9%) had daytime and nighttime urinary incontinence, 11 (9.9%) had daytime urinary incontinence and 15 (13.5%) had nocturnal enuresis. Anticholinergics were started in 18 children, of whom 11 became dry. The other children received only an adequate fluid intake schedule. Eight patients (7.2%) withdrew from study. At study end 69 children (67%) were completely dry during the day and night, 14 (13.6%) remained urinary incontinent during the day and night, 5 (4.9%) had daytime urinary incontinence and 15 (14.6%) had nocturnal enuresis. Of the children 73 (65.8%) drank at least 25% less than the physiologically necessary quantity. Initially 62 children (55.9%) had a small age related expected maximum voided volume, which decreased to 24 (21.6%) at end of study.

Adequate fluid intake is an important part of urotherapy for urinary incontinence in mentally and/or motor disabled children.