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Association between a constipation scoring system adapted for use in children and the dysfunctional voiding symptom
G E de Abreu1, A P Dias Souto Schmitz1, E R Dourado1
1Clinic for Urinary Disorders in Childhood (CEDIMI), Bahia School of Medicine and Public Health, Federal University of Bahia, Salvador, Bahia, Brazil.
Insights
A modified constipation scoring system showed that functional constipation (FC) severity correlates with lower urinary tract symptoms (LUTS) in children. This tool also identified bowel dysfunction in non-constipated children, suggesting its importance in LUTS treatment.
Area of Science:
- Pediatric Urology
- Pediatric Gastroenterology
- Clinical Research
Background:
- The association between lower urinary tract symptoms (LUTS) and functional constipation (FC) in children is presumed but not well-established.
- Existing criteria like Rome IV do not quantify FC severity, necessitating a refined assessment tool.
Purpose of the Study:
- To evaluate the correlation between FC severity, using a modified constipation scoring system, and LUTS severity in pediatric patients.
- To assess the correlation between the modified constipation scoring system and the Rome IV criteria for constipation.
Main Methods:
- A cross-sectional study included 128 pediatric patients (5-17 years) with LUTS, excluding those with anatomical or neurological abnormalities.
- Lower urinary tract dysfunction (LUTD) was diagnosed using the Dysfunctional Voiding Symptom Score (DVSS).
- FC was identified using Rome IV criteria, and its severity was classified using a modified, adapted constipation scoring system (mild, moderate, severe).
Main Results:
- 83.6% of patients had LUTD, more common in girls.
- 62.5% of patients had FC.
- A moderate correlation (ρ=0.5) was found between the modified constipation score and DVSS, indicating a link between FC and LUTS severity.
- A strong correlation (ρ=0.7) existed between the number of Rome IV criteria met and the constipation score.
- The modified system identified mild FC in 30 patients not meeting Rome IV criteria for constipation, suggesting occult bowel dysfunction.
Conclusions:
- The modified constipation scoring system shows a correlation with LUTS/LUTD severity in children.
- The system aligns with Rome IV criteria in constipated patients but also detects bowel dysfunction in non-constipated individuals.
- This modified scoring system holds potential for research and prognostic assessment in pediatric LUTS and FC.
Introduction:
A presumed association between more severe lower urinary tract symptoms (LUTS) and more severe functional constipation (FC) remains unconfirmed. Because the Rome IV criteria do not quantify FC, an adult constipation scoring system was modified and adapted for use in children.
Objectives:
The objective of this study was to assess the correlation between FC severity as determined by the modified constipation scoring system and LUTS severity in children/adolescents and the correlation between this modified scoring system and the Rome IV criteria.
Study Design:
This was a cross-sectional study including 5- to 17-year-old patients with LUTS, with or without FC. Patients with neurological and/or anatomical abnormalities of the genitourinary and/or gastrointestinal tract were excluded. Girls with Dysfunctional Voiding Symptom Score (DVSS) ≥6 and boys with DVSS ≥9 were diagnosed with lower urinary tract dysfunction (LUTD). Patients with at least two positive Rome IV criteria were considered constipated. The severity of FC according to the adapted constipation scoring system was classified as mild for scores of 1-10, moderate for scores 11-20, and severe for scores 21-30.
Results:
Of 128 patients with LUTS, 71 (55.5%) were female. Lower urinary tract dysfunction was detected in 107 patients (83.6%) and was more common in girls. Functional constipation was present in 80 patients (62.5%). Constipated children had higher constipation scores and DVSS, with both scores increasing with the severity of FC. Correlation was moderate between the constipation score and the DVSS (þ = 0.5, p < 0.001) and was strong between positivity for a greater number of Rome IV criteria and the constipation score (þ = 0.7, p < 0.001). Most of the constipated patients had mild or moderate FC, while in 30 non-constipated patients, the constipation score indicated mild FC.
Discussion:
Patients from a specialist center are more likely to have more severe medical problems, and this may have influenced the correlation between the scores. The modifications made to the constipation scoring system require a future validation study. Nevertheless, this study provides new data on urinary dysfunction and its association with FC and highlights the need to investigate occult bowel symptoms that could affect the treatment of urinary dysfunction.
Conclusion:
The intensity of FC as measured by the modified constipation scoring system correlated with the severity of the urinary symptoms in children/adolescents with LUTS/LUTD. In constipated patients, there was a correlation between the modified constipation scoring system and the Rome IV criteria. In non-constipated patients, the constipation scoring system identified symptoms/signs of bowel dysfunction not picked up by the Rome IV criteria. Finally, constipation score modified for use in children and adolescents could be important for research purpose and particularly having a prognostic importance.
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