Authors from Belgium, the Netherlands and Germany tried to clarify the relationship between disordered defecation and non‐neuropathic bladder‐sphincter dysfunction; they found few arguments for a casual relationship between these conditions. OBJECTIVE To clarify the relationship between disordered defecation and non‐neuropathic bladder‐sphincter dysfunction (NNBSD) by comparing the prevalence of symptoms of disordered defecation in children with NNBSD before and after treatment for urinary incontinence (UI), and assessing the effect of such symptoms on the cure rate for UI. PATIENTS AND METHODS In the European Bladder Dysfunction Study, a prospective multicentre study comparing treatment plans for children with NNBSD, 202 children completed questionnaires on voiding and on defecation, at entry and after treatment for UI. Four symptoms of disordered defecation were evaluated; low defecation frequency, painful defecation, fecal soiling, and encopresis. RESULTS At entry, 17 of the 179 children with complete data sets had low defecation frequency and/or painful defecation (9%), classified as functional constipation (FC). Of the 179 children, 57 had either isolated fecal soiling or soiling with encopresis (32%), classified as functional fecal incontinence (FFI). After treatment for UI, FFI decreased to 38/179 (21%) (statistically significant, P = 0.035); for FC there were too few children for analysis. After treatment for UI, 19 of the 179 children (11%) reported de novo FFI. Symptoms of disordered defecation did not influence the cure rate of treatment for UI. CONCLUSIONS FFI improved significantly after treatment for UI only, but not in relation to the outcome of such treatment. FFI did not influence the cure rate for UI. There was little to support a causal relation between disordered defecation and NNBDS (‘functional elimination syndrome’).

Compared with the published data on the natural course of incontinence, the urotherapy program evaluated in this study resulted in higher success rates. Compared with 6-month follow-up, improvement rates proved to be stable, and cure rates (with the exception of patients with night-time wetting in the outpatient training group) even increased significantly during the 2-year follow-up.

Health related quality of life of children and adolescents with urinary incontinence appears to be comparable to that in pediatric patients with other chronic conditions, eg asthma or epilepsy.

No abstract

The German version of the Pediatric Incontinence Questionnaire is a valid and reliable outcome measure to assess health related quality of life in children and adolescents with urinary incontinence.