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Behavioural problems in children with urge incontinence and voiding postponement: a comparison of a paediatric and
A von Gontard1, B Lettgen, H Olbing
1Department of Child and Adolescent Psychiatry, University of Cologne, Köln, Germany.
Insights
Children with voiding postponement show more behavioral issues, while those with urge incontinence have fewer, though both groups experience emotional distress from wetting. This study highlights distinct behavioral patterns in pediatric voiding dysfunction.
Area of Science:
- Pediatric Urology
- Child Psychiatry
- Behavioral Science
Background:
- Urge incontinence and voiding postponement are common pediatric conditions with potential behavioral comorbidities.
- Understanding the psychological impact and behavioral profiles of these conditions is crucial for effective management.
Purpose of the Study:
- To prospectively analyze the incidence of behavioral disorders in children with urge incontinence and voiding postponement.
- To compare the subjective experiences and emotional impact of wetting in these two pediatric groups.
Main Methods:
- A prospective study involving 94 children aged 5.0-10.9 years diagnosed with either voiding postponement or urge incontinence.
- Utilized intelligence testing, the Child Behaviour Checklist (CBCL), ICD-10 psychiatric diagnoses, and structured interviews for comprehensive assessment.
Main Results:
- Children with voiding postponement exhibited significantly higher rates of externalizing behavioral symptoms and psychiatric diagnoses compared to those with urge incontinence.
- Urge incontinent children showed a lower incidence of behavioral problems, primarily emotional/internalizing, with a rate only slightly elevated from the general population.
- Despite differing behavioral profiles, both groups reported significant emotional suffering due to wetting, with no significant differences in their subjective appraisal of the condition's impact.
Conclusions:
- Voiding postponement is strongly associated with a higher incidence of behavioral problems, particularly externalizing behaviors, in children.
- Urge incontinence is linked to a lower incidence of behavioral issues, mainly emotional/internalizing, suggesting a different underlying pathophysiology or psychological impact.
- Subjective emotional distress from wetting is a common experience for children with both conditions, underscoring the need for holistic care beyond physical symptoms.
Unlabelled:
OBJECTIVE; To analyse prospectively the incidence of behavioural disorders and the subjective views of children with urge incontinence (defined by detrusor instability, sudden urge symptoms and frequent micturitions) and voiding postponement (characterized by delayed micturition in typical situations and a low voiding frequency) according to an identical protocol in a paediatric and a child psychiatric unit.
Patients And Method:
Ninety-four consecutive or randomly selected children aged 5.0-10.9 years with either voiding postponement (52) or urge incontinence (42) were examined prospectively using an intelligence test (CFT1 or CFT20), the Child Behaviour Checklist (CBCL 4/18), the ICD-10 child psychiatric diagnoses and a structured interview.
Results:
In the groups from both centres combined, those postponing voiding had a significantly higher incidence of externalizing behavioural symptoms (31% vs. 8%; P < 0.01) and total problems (37% vs. 13%; P < 0.05) in the clinical range (CBCL), and a higher rate of at least one ICD-10 child psychiatric diagnosis (54% vs. 29% P < 0.05) and of expansive disorders (31% vs. 5%; P < 0.01). The incidence of children with behavioural symptoms was lower in the paediatric centre, being exceptionally low among urge incontinent children (only 6%, CBCL). In contrast, from the children's subjective appraisal, there were no significant differences in concepts, explanations and implications of wetting; 79% of urge incontinent children and 64% of those postponing voiding suffered emotionally from the adverse effects of wetting. Only a minority (3% vs. 6%) saw any advantages at all.
Conclusion:
Children with voiding postponement had a significantly higher incidence of behavioural problems, especially expansive/externalizing behaviour, 3-4 times higher than in the normal population. Children with urge incontinence had a significantly lower incidence of behavioural problems, mainly emotional/ internalizing behaviour, that was only slightly higher (1-2 times) than that in the normal population. Because of selection, similar trends but lower incidences were found in the paediatric setting, with very few problems among urge incontinent children. In contrast, the children's subjective views did not differ; disadvantages associated with emotional suffering were reported by all children.