Incontinence and constipation in adolescent patients with anorexia nervosa—Results of a multicenter study from a German web‐based registry for children and adolescents with anorexia nervosa

Abstract

Objective Nocturnal enuresis (NE), daytime urinary incontinence (DUI), and fecal incontinence (FI) are common disorders in childhood and are frequently accompanied by comorbid psychiatric disorders. Despite a high association between urinary and fecal incontinence with psychiatric and neurodevelopmental disorders, research on comorbidity between incontinence and anorexia nervosa (AN) remains scarce. Yet, it is well known that somatic consequences of AN include metabolic and gastrointestinal disorders. The study sought to assess the prevalence of incontinence and constipation in children and adolescents with AN and to examine associations of these two symptoms with body weight at admission and with BMI changes during inpatient treatment. Methods Data collected between 2015 and 2017 by a multicenter German web‐based registry for AN were analyzed. Three hundred and forty‐eight patients with AN (96.3% female, mean age = 15.1 ± 1.8 years) were assessed regarding AN subtype, psychiatric comorbidity, body weight, incontinence, and constipation. Results Overall, 27.6% of patients had constipation, 1.8% had NE and 1.8% DUI. Prevalence of constipation did not significantly differ between AN subtypes. Constipation did not lead to any significant differences in weight/BMI changes during inpatient treatment. Discussion This is the largest study of incontinence and constipation in patients with AN, so far. Our results indicate that constipation is highly prevalent in adolescent patients with AN and reflects a clinically relevant condition. Despite, patients with AN do not have an increased prevalence of incontinence compared with the general population. Future studies should include medical examinations like ultrasound and physical examination of the lower abdomen to evaluate the severity of constipation.

Continence problems and mental health in adolescents from a UK cohort

“…Inconsistent findings have been reported by studies of small clinical samples that examined if the prevalence of incontinence is greater in adolescents diagnosed with anorexia compared with the general population. 19 Bedwetting was the least prevalent exposure, which might explain why we found fewer (or only weak evidence of) associations with the mental health problems. We also found few associations between soiling and mental health outcomes.…”

The intersect of gastrointestinal symptoms and malnutrition associated with anorexia nervosa and avoidant/restrictive food intake disorder: Functional or pathophysiologic?—A systematic review

“…Again, however, colonic transit time did not correlate with BMI, self‐reported symptoms, caloric intake on admission, or laxative use. Other studies have also corroborated a lack of correlation between self‐reported constipation and BMI (Mattheus et al, 2020; Sileri et al, 2014). Self‐reports of constipation and duration of ED were found to correlate in one study (Sileri et al, 2014).…”

“…Other studies have also corroborated a lack of correlation between self-reported constipation and BMI (Mattheus et al, 2020;Sileri et al, 2014). Self-reports of constipation and duration of ED were found to correlate in one study (Sileri et al, 2014).…”

Emergency room presentations of people with anorexia nervosa

“…Constipation is another reason why both subtypes of people with AN might seek ED care. All people with AN have markedly prolonged colonic transit time as a result of their weight loss and are at risk for constipation [ 56 ], occurring in approximately 30% of people with AN [ 57 ]. Thus, these patients can suffer with constipation especially those with more severe AN at the beginning of refeeding.…”