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Screening and management of bladder and bowel dysfunction in general pediatric outpatient clinic: a prospective
Achra Sumboonnanonda1, Punnarat Sawangsuk1, Patharawan Sungkabuth2
1Division of Nephrology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
Insights
Bladder and bowel dysfunction (BBD) affects 8.6% of Thai children, often linked to behavioral issues. Standard urotherapy significantly improved symptoms and bowel function in these pediatric patients.
Area of Science:
- Pediatric Urology
- Child Psychology
- Gastroenterology
Background:
- Bladder and bowel dysfunction (BBD) is common in children, frequently co-occurring with psychosocial and behavioral problems.
- Data on BBD prevalence and treatment outcomes in Asian populations, specifically Thai children, are limited.
- This study addresses the scarcity of data by investigating BBD prevalence and urotherapy response in Thai children at a major tertiary referral center.
Purpose of the Study:
- To determine the prevalence of bladder and bowel dysfunction (BBD) among Thai children aged 4-12 years.
- To evaluate the effectiveness of standard urotherapy in treating BBD in this pediatric population.
- To explore the association between BBD and behavioral problems using the Strengths and Difficulties Questionnaire (SDQ).
Main Methods:
- Children aged 4-12 years attending a pediatric outpatient clinic completed the Dysfunctional Voiding Symptom Score (DVSS) questionnaire for BBD screening.
- Children diagnosed with BBD received standard urotherapy, including education and behavior management.
- Patients were followed up at 3 and 6 months, with DVSS scores compared to baseline using repeated measures ANOVA. The SDQ was administered at baseline.
Main Results:
- Out of 1,042 children, 90 (8.6%) had BBD. Common symptoms included defecation frequency, difficult defecation, urgency, and daytime incontinence.
- Children with BBD showed a high prevalence of hyperactivity problems (32.5%) based on SDQ scores.
- Standard urotherapy led to significant improvements in DVSS scores at 3 and 6 months (p < 0.01) and improved Bristol stool scores (p = 0.03).
Conclusions:
- Bladder and bowel dysfunction is a prevalent condition in Thai children, often accompanied by emotional and behavioral challenges.
- Standard urotherapy administered in a general pediatric setting demonstrated positive outcomes for Thai children diagnosed with BBD.
- The findings support the integration of urotherapy into routine pediatric care for managing BBD in this population.
Background:
Bladder and bowel dysfunction (BBD) is a common disorder in children that is often associated with psychosocial and behavioral problems. Data specific to BBD in Asian children are comparatively scarce. Accordingly, this study aimed to investigate the prevalence of BBD and the response to standard urotherapy among Thai children attending the general pediatric outpatient clinic of Siriraj Hospital - Thailand's largest national tertiary referral center. METHODS: Children aged 4-12 years were recruited to complete the Dysfunctional Voiding Symptom Score (DVSS) questionnaire to screen for BBD during 2018 to 2020. Standard urotherapy, which consists of education and behavior management, was prescribed to those with a DVSS score that suggests the presence of BBD. Enrolled children and their caregivers were followed-up at 3 and 6 months. The Strengths and Difficulties Questionnaire (SDQ) was completed at baseline. DVSS scores at baseline, and at 3 months and 6 months after standard urotherapy were compared using repeated measures analysis of variance (ANOVA).
Results:
A total of 1,042 children completed the DVSS during the study period, and 90 (8.6%) were deemed to have BBD. The mean age of BBD children was 6.9 ± 2.2 years, and the female to male ratio was 2.9:1. The most common symptoms were defecation frequency (80.0%), difficult defecation (80.0%), curtsying (74.4%), urgency (68.9%), infrequent voiding (43.3%), and daytime incontinence (32.2%). Forty-one BBD children completed the SDQ, and 32.5% had scores suggestive of hyperactivity problems. Among the 24 BBD patients who were followed-up after 3 and 6 months of standard urotherapy, there was a significant improvement in DVSS results (9.5 ± 3.1 at baseline vs. 6.9 ± 3.4 at 3 months vs. 4.4 ± 3.9 at 6 months; p < 0.01). Nine of 12 patients with urinary incontinence showed complete response at 6 months. The overall Bristol stool score significantly improved from 2.6 ± 0.7 at baseline to 3.2 ± 1.0 at 6 months (p = 0.03).
Conclusions:
BBD is a prevalent condition among Thai children that is often associated with emotional and behavioral problems. Standard urotherapy prescribed in a general pediatric outpatient clinic setting yielded favorable outcomes in Thai children with BBD.
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