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Evaluation of a bladder and bowel training program for therapy-resistant children with incontinence
J Hussong1, H Mattheus1, S Wachs1
1Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany.
Insights
This study shows a manualized bladder and bowel training program effectively treats therapy-resistant childhood incontinence. Daytime urinary incontinence (DUI) and fecal incontinence (FI) symptoms improved, with lasting benefits for DUI and reduced psychological distress.
Area of Science:
- Pediatric Urology
- Gastroenterology
- Behavioral Therapy
Background:
- Daytime urinary incontinence (DUI) and fecal incontinence (FI) are common in children.
- Standard treatments are effective, but some children have therapy-resistant or chronic conditions, including those with nocturnal enuresis (NE) or psychological comorbidities.
Purpose of the Study:
- To prospectively evaluate the treatment effects of a manualized outpatient bladder and bowel training program for children with therapy-resistant incontinence.
- To assess the long-term effectiveness of the program at a 6-month follow-up.
Main Methods:
- A group or individual training program was administered to 32 children (aged 5-16) with therapy-resistant incontinence.
- The program included education on urogenital anatomy/physiology, nutrition, hygiene, and techniques for voiding, drinking, stress management, and emotion regulation.
- Children were assessed before, after, and 6 months post-treatment using incontinence frequency, International Consultation on Incontinence-Consultation on Incontinence (ICCS) criteria, and the Child Behavior Checklist (CBCL).
Main Results:
- Daytime urinary incontinence (DUI) episodes decreased significantly from 5.7/week pre-training to 2.0/week at 6-month follow-up.
- Fecal incontinence (FI) episodes reduced from 2.9/week to 1.9/week post-training, with 33.3% achieving complete response, though frequency increased to 2.6/week at follow-up.
- Complete response rates for DUI were 11.1% post-training and 47.6% at follow-up; for FI, 33.3% post-training and 25% at follow-up.
- Psychological symptoms, particularly internalizing behaviors, significantly decreased during training.
- Comorbid nocturnal enuresis (NE) episodes reduced from 5.9/week to 1.5/week at follow-up.
Conclusions:
- The manualized bladder and bowel training program is an effective treatment for therapy-resistant childhood incontinence subtypes.
- Symptom improvement, especially for DUI, was sustained or improved at 6 months post-training.
- The program also effectively reduces associated psychological symptoms in children.
Introduction:
Daytime urinary incontinence (DUI) and fecal incontinence (FI) are common disorders in children. Although standard treatment is highly effective, subgroups of incontinence (combinations of nocturnal enuresis (NE), DUI and/or FI, or with psychological comorbidity) can relapse or take a chronic course. For these complex, therapy-resistant cases, a manualized outpatient bladder and bowel training program was developed. The aim of the study was to evaluate prospectively treatment effects of this training program, including a follow-up assessment.
Material & Methods:
The training program was developed for small groups of 2-6 children (of same age and sex) aged 5-12 years with adaptations for 13-16 year-old adolescents. It consists of 7-9 weekly sessions for group training and 3 weekly sessions for individual training. The training comprises information about anatomy/physiology of the urogenital tract, pathophysiology, hygiene and balanced nutrition. Voiding and drinking diaries, stress management, relaxation and emotion regulation techniques are also included. Data of 32 children (mean age 8.6 years, range 5-13 years; 21 boys), who had received standard treatment (and did not reach complete response) are presented. 14 children received group therapy, 18 (younger children) were treated individually. Children were assessed before and after the treatment, as well as at a follow-up of 6 months later. Treatment effects were measured by incontinence frequency and treatment success according to the ICCS (complete response: 100% reduction of symptoms; partial response: 50-99% reduction of symptoms). Psychological symptoms were measured by the Child Behavior Checklist questionnaire (CBCL).
Results:
Frequencies of DUI were significantly reduced from 5.7 wetting episodes/week (before training) to 4.9 (after training) to 2.0 (6 months after training). Frequencies of FI were reduced from 2.9 soiling episodes/week (before training) to 1.9 (after training), but increased to 2.6 (6 months after training). According to the ICCS classification, 11.1% of children with DUI had a complete response after training and 47.6% at follow-up after 6 months. In children with FI, 33.3% reached a complete response at the end of the training and 25% at follow-up. Additionally, psychological symptoms, especially internalizing, decreased significantly during training. Further, in 14 children with comorbid NE, nighttime wetting reduced from 5.9 before training to 1.5 episodes/week at follow-up.
Conclusions:
This bladder and bowel training program is an effective and successful treatment option for children with therapy-resistant subtypes of incontinence. Symptoms still improved 6 months after training in DUI. Additionally, the training program is helpful to decrease psychological symptoms.
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