Urge incontinence and voiding postponement in children: somatic and psychosocial factors

• Published in: Acta Paediatrica 2002-09, Vol.91 (9), p.978-984
• Main Authors: Lettgen, B, von Gontard, A, Olbing, H, Heiken-Löwenau, C, Gaebel, E, Schmitz, I
• Format: Article
• Language: English
• Subjects: Age Distribution; Behavioural disorders; Biological and medical sciences; Child; Child Behavior Disorders - diagnosis; Child Behavior Disorders - epidemiology; Child Behaviour Checklist; Child, Preschool; day wetting children; FACES-III; Female; Germany - epidemiology; Humans; Male; Medical sciences; Nephrology. Urinary tract diseases; Probability; Prognosis; Prospective Studies; Psychology; Risk Assessment; Risk Factors; Sampling Studies; Sex Distribution; urge incontinence; Urinary Incontinence - diagnosis; Urinary Incontinence - epidemiology; Urinary Incontinence - psychology; Urinary system involvement in other diseases. Miscellaneous; urinary tract infections; Urinary Tract Infections - diagnosis; Urinary Tract Infections - epidemiology; Urinary tract. Prostate gland; Urination Disorders - diagnosis; Urination Disorders - epidemiology; Urodynamics; uroflowmetry; voiding postponement
• ISSN: 0803-5253; 1651-2227
• DOI: 10.1111/j.1651-2227.2002.tb02888.x

Aim: To analyse the number of urinary tract infections, uroflowmetry, behavioural symptoms and intrafamilial interaction in two groups of daytime wetting children in a paediatric and a child psychiatric unit. Methods: Ninety‐four children with either voiding postponement (52) or urge incontinence (42) were examined prospectively for history of urinary tract infections (UTIs), uroflowmetry, the syndrome scales of the Child Behaviour Checklist (CBCL 4/18‐Achenbach) and the Family Adaptability and Cohesion Evaluation Scales (FACES‐III) (Olson) questionnaire. Results: Children with urge incontinence had a significantly higher rate of previous urinary tract infections (50%) than children with voiding postponement (19.2%; p > 0.001), who showed a high rate of plateau (12.2%) and staccato (20.4%) curves and were characterized by a wide variety of behavioural symptoms, including withdrawn (11.6%), aggressive (11.8%), delinquent (19.6%) behaviour and attention problems (13.7%). Clinically relevant behavioural scores were 4–10 times higher for the voiding postponers, and 2–3 times higher for children with urge incontinence. Furthermore, families of voiding postponers had significantly fewer balanced types of intrafamilial function (FACES‐III). Problematic “rigid/disengaged” and “rigid/separated” types predominated. Conclusion: Urge incontinence is characterized by a higher rate of UTIs, a lower urine volume in uroflowmetry, a lower rate of behavioural scores in the clinical range and well‐functioning families. Voiding postponement children, on the other hand, have a higher, though not significant, rate of abnormal uroflow curves, a wide variety of clinically relevant behavioural symptoms, which were significantly higher for attention and delinquent problems. Conduct problems predominated; only 13.7% of the children had attention problems in the clinical range. The findings lend empirical support to the entity of voiding postponement as an acquired or behavioural syndrome characterized by wetting in association with a delay of micturition and other externalizing conduct problems.