Risk Factors for Daytime or Combined Incontinence in Children with Cerebral Palsy
Bieke Samijn1, Christine Van den Broeck2, Ellen Deschepper3
1Department of Uro-gynaecology, Ghent University, Ghent, Belgium; Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium.
Insights
Risk factors for urinary incontinence in children with cerebral palsy (CP) include intellectual disability and functional impairment. Fluid intake also plays a role in continence for children with CP.
Area of Science:
- Pediatric Urology
- Neurology
- Developmental Disabilities
Background:
- Urinary incontinence is a common challenge for children with cerebral palsy (CP).
- Identifying risk factors is crucial for targeted interventions and improved quality of life.
Purpose of the Study:
- To identify and analyze risk factors associated with daytime or combined urinary incontinence in children with cerebral palsy.
- To develop a predictive model for urinary incontinence in this population.
Main Methods:
- A cross-sectional case-control study involving children with and without urinary incontinence.
- Data collection included uroflowmetry with electromyography, questionnaires, and bladder diaries.
- Univariate, multivariate, and logistic regression analyses were employed.
Main Results:
- Intellectual disability, swallowing problems, use of external aids, and laxative use were significant risk factors.
- CP classification factors like dyskinesia, bilateral involvement, and higher Gross Motor Function Classification System levels were associated with incontinence.
- Lower maximum voided volume and reduced oral fluid intake were negatively associated with continence.
Conclusions:
- Functional impairment, intellectual disability, and oral fluid intake are key predictive factors for urinary incontinence in children with CP.
- These findings highlight the importance of a holistic approach to managing continence in children with cerebral palsy.
Purpose:
We identify risk factors for daytime or combined urinary incontinence in children with cerebral palsy.
Materials And Methods:
A cross-sectional case-control study was conducted including children with cerebral palsy with or without daytime or combined urinary incontinence from the CP-Reference Center at Ghent University Hospital and 2 associated special education schools. Factors were subdivided in 3 clusters of demographic and general medical data, cerebral palsy classification, and bladder and bowel dysfunction. Data were obtained using uroflowmetry with electromyography testing, a nonvalidated questionnaire and bladder diaries. Univariate and multivariate analyses were performed for variables and clusters, respectively. A final associative logistic model including all clusters was developed.
Results:
The study included 34 incontinent children and 45 continent children. Daytime or combined urinary incontinence was associated with intellectual disability (OR 7.69), swallowing problems (OR 15.11), use of external aids (OR 27.50) and use of laxatives (OR 13.31). Daytime or combined urinary incontinence was positively associated with dyskinesia (OR 5.67) or combined spasticity and dystonia (OR 4.78), bilateral involvement (OR 4.25), Gross Motor Function Classification System level IV (OR 10.63) and V (OR 34.00), and severe impairment in manual (OR 24.27) or communication skills (OR 14.38). Lower maximum voided volume (OR 0.97) and oral fluid intake (OR 0.96) influenced daytime or combined urinary incontinence negatively. Pathological uroflow curves were not significantly associated with incontinence. The final model defined functional impairment, intellectual disability and oral fluid intake as predictive factors for daytime or combined urinary incontinence.
Conclusions:
Risk analysis revealed functional impairment, intellectual disability and fluid intake as important factors influencing continence in a child with cerebral palsy.
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