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Updated: May 12, 2026
Real-Time Void Spot Assay
Published on: February 10, 2023
Dysfunctional elimination syndromes--how closely linked are constipation and encopresis with specific lower urinary
Andrew J Combs1, Jason P Van Batavia, Jennifer Chan
1Division of Pediatric Urology, Morgan Stanley Children's Hospital of New York-Presbyterian, Department of Urology, Columbia University, College of Physicians and Surgeons, New York, New York 10032, USA.
Insights
Constipation and encopresis are common in children with lower urinary tract conditions, particularly dysfunctional voiding. Treatment of detrusor overactivity with anticholinergics resolved encopresis in most cases.
Area of Science:
- Pediatric Urology
- Gastroenterology
- Child Health
Background:
- Bladder and bowel dysfunction frequently coexist in children.
- Understanding these associations is crucial for effective diagnosis and treatment.
Purpose of the Study:
- To determine the association between constipation and/or encopresis with specific lower urinary tract conditions in children.
- To investigate the prevalence of bowel dysfunction in pediatric lower urinary tract conditions.
Main Methods:
- Retrospective review of a database of children with lower urinary tract dysfunction.
- Categorization of bowel dysfunction (constipation, encopresis, or both) and lower urinary tract conditions.
- Statistical analysis to determine associations between bowel and bladder conditions.
Main Results:
- Constipation was the most common bowel dysfunction (27%), more prevalent in girls.
- Encopresis was more common in boys and often associated with urgency and detrusor overactivity.
- Dysfunctional voiding showed the highest incidence of associated bowel dysfunction.
Conclusions:
- Half of children with lower urinary tract conditions exhibited active bowel dysfunction.
- Constipation linked to dysfunctional voiding; encopresis associated with idiopathic detrusor overactivity and dysfunctional voiding.
- Anticholinergic therapy for detrusor overactivity effectively resolved encopresis in most cases.
Purpose:
It is recognized that there is a strong association between bladder and bowel dysfunction. We determined the association of constipation and/or encopresis with specific lower urinary tract conditions.
Materials And Methods:
We reviewed our database of children with lower urinary tract dysfunction and divided cases into 3 categories of bowel dysfunction (constipation, encopresis and constipation plus encopresis) and 4 lower urinary tract conditions (dysfunctional voiding, idiopathic detrusor overactivity disorder, detrusor underutilization disorder and primary bladder neck dysfunction). Associations between bowel dysfunction types and each lower urinary tract condition were determined.
Results:
Of 163 males and 205 females with a mean age of 8.5 years constipation was the most common bowel dysfunction (27%). Although encopresis is generally thought to reflect underlying constipation, only half of children with encopresis in this series had constipation. Dysfunctional voiding was associated with the highest incidence of bowel dysfunction. All but 1 patient with encopresis had associated urgency and detrusor overactivity, and the encopresis resolved in 75% of patients after initiation of anticholinergic therapy. Constipation was significantly more common in girls (27%) than in boys (11%, p <0.01), while encopresis was more common in boys (9%) than in girls (3%, p = 0.02), likely reflecting the higher incidence of dysfunctional voiding in girls and idiopathic detrusor overactivity disorder in boys.
Conclusions:
Active bowel dysfunction was seen in half of the children with a lower urinary tract condition. Constipation was more common in patients with dysfunctional voiding, while encopresis was significantly increased in those with idiopathic detrusor overactivity disorder and in those with dysfunctional voiding, severe urgency and detrusor overactivity. Anticholinergics, despite their constipating effect, given for treatment of detrusor overactivity resolved encopresis in most children with this bowel dysfunction.
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