Development of bladder control in mentally handicapped children

Abstract

Purpose: To analyze the role of mental handicap as a possible source of lack of development of bladder control and to find out the chance of continence to advise future patients.Materials and Methods: The parents and relatives of 100 consecutive mentally handicapped patients were inquired by a personal interview. Questions included the age when they stopped using diapers, enuretic events, frequency, urgency and leakage episodes, urinary infections. Etiology of their mental problem was unknown in 34, perinatal anoxia in 17, Down syndrome in 15, phenylketonuria in 18 and others minors causes. The grade of mental deficiency were profound in 1, severe in 10, moderate in 39, mild in 33 and normal inferior value in 17. The age varied from 7 to 37 years old, with an average of 14 by the time of the interview, comprising 60 males and 40 females.Results: All profound and severe patients presented leakage episodes regardless of the age. The mild and normal inferior value acquired progressive urinary control with aging, and 33% still remain with urinary symptoms above 16 years old. Urinary infection was similar in males and females, around 29%. The most committed group presented less urinary infections. The etiology of the mental handicap was not correlated to the incidence of urinary leakage.Conclusions: The lack of bladder control was correlated to the grade of mental handicap. In severe and profound groups, the expectancy of control is disappointing. In the less compromised groups, there is a delay in bladder training, with achievement of control in 2/3 after 16 years of age. Those in the normal inferior value have a chance of postponed urinary control, easily misdiagnosed by normal urological interviews.

Incontinence in persons with Down Syndrome

“…Kitamura et al reported overall rates of 47% for urinary incontinence in 5‐15 year‐old children with DS. In a smaller sample ( n = 15), urinary leakages affected 73% of 7‐10 year old children with DS . In another study of 78 persons with DS and a mean age of 10.3 years (range 0–27 years), 46% had urinary incontinence in total (20% had NE only, 35% DUI only, and 45% both) …”

“…One explanation for these higher rates of NE and DUI in children with DS is a general delay of bladder control, which is strongly associated with the severity of ID . Central nervous system (CNS) mechanisms are involved in DUI and NE .…”

“…The rates for NE (49.4%) and DUI (47.3%) are comparable to other studies on children with DS. Kitamura et al 10 reported overall rates of 47% for urinary incontinence in [5][6][7][8][9][10][11][12][13][14][15] year-old children with DS. In a smaller sample (n = 15), urinary leakages affected 73% of 7-10 year old children with DS.…”

“…In children with DS, incontinence rates range between 46% and 73% . Rates are higher in children with lower IQ and with lower urinary tract symptoms (LUTS) .…”

“…8 In children with DS, incontinence rates range between 46% and 73%. [9][10][11] Rates are higher in children with lower IQ 11 and with lower urinary tract symptoms (LUTS). 12 Children with DS are also at risk for constipation (50%), LUTS (27%), pathological uroflows (66%), and a delayed toilet training (81.2% after 5 years of age).…”