Bladder-Bowel Dysfunction in Children: Consequences, Risk Factors and Recommendations for Primary Care Interventions
The goals of this paper are to review potential risk factors and emerging insights into nature of bladder-bowel dysfunction (BBD) and highlight a patient-centered approach to management, which can begin in the primary care setting.
(1) BBD is documented in about half of patients with vesicoureteral reflux and increases potential for renal scarring. (2) Neurodevelopmental and environmental factors are associated with BBD and greater understanding of a neurocentric basis for BBD is emerging. (3) A patient-centered approach to care is required. The way in which children and adolescents understand their bladder, bowel, or continence problem can influence coping strategies and adherence to treatment.
Early identification and treatment of BBD is important to prevent significant medical and social burden. The primary care provider with foundational knowledge of the causes and risk factors for BBD and an established relationship with a patient and family is well suited to identify BBD and begin management.
KeywordsBladder bowel dysfunction Constipation Children Urinary tract infection Incontinence Treatment
Compliance with Ethical Standards
Conflict of Interest
The author declares that she has no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 3.• Shaikh N, Hoberman A, Keren R, Gotman N, Docimo SG, Mathews R, et al. Recurrent urinary tract infections in children with bladder and bowel dysfunction. Pediatrics. 2016;137(1):e20152982. Describes the clinical characteristics and outcomes of children with BBD in the setting of vesicoureteral reflux based on data from the RIVUR and CUTIE studies. CrossRefPubMedCentralGoogle Scholar
- 4.• Yang S, Chua ME, Bauer S, Wright A, Brandström P, Hoebeke P, et al. Diagnosis and management of bladder bowel dysfunction in children with urinary tract infections: a position statement from the International Children’s Continence Society. Pediatr Nephrol. 2017:1–13. A concensus view from the ICCS on the evaluation and management of BBD in children with urinary tract infections. Google Scholar
- 22.Burgers RE, Mugie SM, Chase J, Cooper CS, Von Gontard A, Rittig CS, et al. Management of functional constipation in children with lower urinary tract symptoms: report from the Standardization Committee of the International Children’s Continence Society. J Urol. 2013;190(1):29–36.CrossRefPubMedGoogle Scholar
- 24.Austin PF, Bauer SB, Bower W, Chase J, Franco I, Hoebeke P, et al. The standardization of terminology of lower urinary tract function in children and adolescents: update report from the Standardization Committee of the International Children’s Continence Society. J Urol. 2014;191(6):1863–5.CrossRefPubMedGoogle Scholar
- 36.• Ko LN, Chuang K, Champeau A, Allen IE, Copp HL. Lower urinary tract dysfunction in elementary school children: results of a cross-sectional teacher survey. J Urol. 2016;195(4):1232–8. A large-scale survey of elementary school teacher across the US on their policies for bathroom use reveals they fail to promote urinary tract health. CrossRefPubMedPubMedCentralGoogle Scholar
- 41.• Von Gontard A, de Jong TPVM, Badawi JK, O’Connell KA, Hanna-Mitchell AT, Nieuwhof-Leppink A, et al. Psychological and physical environmental factors in the development of incontinence in adults and children: a comprehensive review. J Wound Ostom Cont Nurs. 2017;44(2):181–7. An excellent review of environmental etiological factors related to incontinence in children and adults. CrossRefGoogle Scholar
- 49.• Whale K, Cramer H, Wright A, Sanders C, Joinson C. “What does that mean?”: a qualitative exploration of the primary and secondary clinical care experiences of young people with continence problems in the UK. BMJ Open. 2017;7(10):e015544. Qualitative interviews with 20 young people with incontinence shed light on their experience with care and highlights the importance of the clinician-patient relationship, communication style, and shared decision-making. CrossRefPubMedPubMedCentralGoogle Scholar
- 63.Storm DW, Lockwood GM, Cooper CS. Foreword on the evolution of the multidisciplinary pediatric voiding dysfunction clinic and move towards standardization of treatment protocols. Curr Bladder Dysfunct Rep. 2018; https://doi.org/10.1007/s11884-018-0460-9.
- 65.Brownrigg N, Braga LH, Rickard M, Farrokhyar F, Easterbrook B, Dekirmendjian A, et al. The impact of a bladder training video versus standard urotherapy on quality of life of children with bladder and bowel dysfunction: a randomized controlled trial. J Pediatr Urol. 2017;13(4):374.e1–8.CrossRefGoogle Scholar