Abstract Title: Determining Best Treatments for Pediatric Bowel and Bladder Dysfunction

Introduction and objectives Bowel and bladder dysfunction (BBD) describes a spectrum of symptoms including urinary and stool incontinence, urgency, frequency, painful urination, and constipation that accounts for over 40% of all pediatric urology clinic visits. Children with BBD may also suffer from recurrent UTIs, which can cause renal scarring and reduced kidney function. In addition to the urinary and gastrointestinal issues, BBD has a profound impact on a child’s mental health, self-esteem, and social development. Given the impact of these issues, it is important not only to properly diagnose BBD, but provide an effective treatment plan. Unfortunately, no defined criteria currently exist as to which therapies should be used by clinicians despite the wide range of treatment options including: urotherapy (timed voiding schedule), stool softeners, anticholinergics, desmopressin, electrical stimulation, surgical interventions, and pelvic floor physical therapy.

Methods A retrospective chart review was performed to analyze questionnaire and treatment data from patients who presented to our pediatric urology clinic for evaluation and treatment of BBD within the last 5 years. Results from a BBD questionnaire were recorded at each clinic visit as well as the treatment each patient received. A self-administered 5-point Likert scale was used to assess the severity of each patient's BBD symptoms and the results were compared from the patient’s first to final visit. The questionnaire classified BBD symptom severity and frequency into eight subscales. The mean change in each subscale demonstrated the efficacy of each intervention studied.

Results Data from 300 patients was reviewed and included in the study. The average patient age was 6.1 years and included 89 males (30%) and 211 females (70%). Stool softeners demonstrated statistically significant improvement in the subscales of regularity of bowel movements, decreased stool accidents, and decreased pain and straining associated with bowel movements. Urotherapy significantly reduced daytime urinary incontinence. Stool softeners and anticholinergics each independently reduced urinary holding and straining. The limitations of the study were the concurrent interventions and subjective nature of the questionnaire data.

Conclusion In addition to effectively managing constipation symptoms, stool softeners reduced daytime urinary incontinence and improved urinary holding and straining, underscoring the efficacy of stool softeners across multiple domains of BBD and highlighting the interplay between bowel and bladder function. Finally, our study demonstrated that the behavioral intervention of urotherapy was more effective than the medical management of daytime urinary incontinence in pediatric BBD.