Screening and management of bladder and bowel dysfunction in general pediatric outpatient clinic: a prospective observational study

Abstract

Background Bladder and bowel dysfunction (BBD) is a common disorder in children that is often associated with psychosocial and behavioral problems. Data specific to BBD in Asian children are comparatively scarce. Accordingly, this study aimed to investigate the prevalence of BBD and the response to standard urotherapy among Thai children attending the general pediatric outpatient clinic of Siriraj Hospital – Thailand’s largest national tertiary referral center. Methods Children aged 4–12 years were recruited to complete the Dysfunctional Voiding Symptom Score (DVSS) questionnaire to screen for BBD during 2018 to 2020. Standard urotherapy, which consists of education and behavior management, was prescribed to those with a DVSS score that suggests the presence of BBD. Enrolled children and their caregivers were followed-up at 3 and 6 months. The Strengths and Difficulties Questionnaire (SDQ) was completed at baseline. DVSS scores at baseline, and at 3 months and 6 months after standard urotherapy were compared using repeated measures analysis of variance (ANOVA). Results A total of 1,042 children completed the DVSS during the study period, and 90 (8.6%) were deemed to have BBD. The mean age of BBD children was 6.9 ± 2.2 years, and the female to male ratio was 2.9:1. The most common symptoms were defecation frequency (80.0%), difficult defecation (80.0%), curtsying (74.4%), urgency (68.9%), infrequent voiding (43.3%), and daytime incontinence (32.2%). Forty-one BBD children completed the SDQ, and 32.5% had scores suggestive of hyperactivity problems. Among the 24 BBD patients who were followed-up after 3 and 6 months of standard urotherapy, there was a significant improvement in DVSS results (9.5 ± 3.1 at baseline vs. 6.9 ± 3.4 at 3 months vs. 4.4 ± 3.9 at 6 months; p < 0.01). Nine of 12 patients with urinary incontinence showed complete response at 6 months. The overall Bristol stool score significantly improved from 2.6 ± 0.7 at baseline to 3.2 ± 1.0 at 6 months (p = 0.03). Conclusions BBD is a prevalent condition among Thai children that is often associated with emotional and behavioral problems. Standard urotherapy prescribed in a general pediatric outpatient clinic setting yielded favorable outcomes in Thai children with BBD.

Validation of the Vancouver Symptom Score Questionnaire for bladder and bowel dysfunction for Brazilian children and adolescents

“…The authors also showed that a score of 11 had diagnostic sensitivity and specificity of 80% and 91%, respectively. The high sensitivity and specificity of the VSS questionnaire indicate that this instrument is a valuable screening tool, since it allows the early identification and referral of children and adolescents with symptoms of BBD to specialized centers ( 3 , 5 , 7 , 9 – 11 ). The early diagnosis and adequate multidisciplinary treatment can avoid the repercussions for the upper urinary tract mainly represented by renal scars ( 5 ).…”

“…Early recognition and non-invasive management of BBD in children and adolescents in a general outpatient setting plays an important role in reducing morbidity ( 5 , 7 ). Several validated voiding scales are useful for this purpose ( 3 , 5 ), including the Dysfunctional Voiding Symptom Score (DVSS) ( 8 ) and the Vancouver Symptom Score (VSS) ( 9 ).…”

Evaluation of Splanchnic Blood Flow Using Doppler Ultrasound Before and After Constipation Treatment in Patients with Bladder and Bowel Dysfunction

“…In the present study, similar to what has been reported in the literature, BBD was more commonly observed in girls. [2] Diagnosis of BBD is typically based on the patient's anamnesis and physical examination. [8] Most children do not require any diagnostic tests.…”

“…LUTS can present with symptoms such as incontinence, frequent urination, sudden need to urinate, di culty initiating urination, straining to urinate, weak urine ow, intermittent urination, and dysuria. [2] Thus, complications such as urinary tract infections, vesicoureteral re ux (VUR), and/or renal function loss may occur. [2] An early diagnosis and treatment of constipation in these patients can help prevent complications by preventing chronic progression of LUTS symptoms.…”

“…[2] Thus, complications such as urinary tract infections, vesicoureteral re ux (VUR), and/or renal function loss may occur. [2] An early diagnosis and treatment of constipation in these patients can help prevent complications by preventing chronic progression of LUTS symptoms. In bladder and bowel dysfunction, plain abdominal radiograph and/or ultrasonographic transverse diameter of the rectum is used for diagnosis along with anamnesis and physical examination.…”