Childhood Functional Urinary Incontinence and School Performance: A Nationwide Matched Cohort Study

Childhood urinary incontinence (UI) is a common disorder with significant negative impact on self-esteem and quality of life, but the impact on school performance is unknown. This study investigates how UI in children is associated with school performance.

This is a nationwide matched cohort study of children born in Denmark to Danish parents between 1997 and 2008 investigating association between UI and results from standardized National School Tests from 2010 to 2018 (1- to 100-point scale). Multiple linear regression estimated difference (∆) in test scores between children with UI and matched references after adjusting for relevant confounders. Subanalyses investigated the influence of psychiatric disorders (PDs) and age at treatment onset.

Overall, children with UI (n = 42,999) performed comparably with the matched reference children (n = 429,999; ∆ range -2.5 to +0.6 points). Children with UI co-occurring with PDs scored substantially lower than the reference population, most pronounced for attention-deficit/hyperactivity disorder (∆ range -3.7 to -11.2 points). Children with nocturnal enuresis aged 11 years and older at treatment onset had lower overall school performance than children aged 5 to 7 years at treatment onset (∆ -2.9 [95% CI, -4.0 to -1.7]).

School performance in children with UI was normal. However, because PDs are more prevalent in UI and children with UI and co-occurring PDs had significantly lower school performance, we recommend assessing for PDs in UI. Children with late treatment onset had lower school performance than children with early treatment onset; further research is needed on the effect of delayed treatment on children with UI.