Trajectories of urinary incontinence in childhood and bladder and bowel symptoms in adolescence: prospective cohort study

Jon Heron, Mariusz Tadeusz Grzeda, Alexander von Gontard, Anne Wright, Carol Joinson

Research output: Contribution to journalArticle (Academic Journal)peer-review

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Abstract

Objectives: To identify different patterns (trajectories) of childhood urinary incontinence and examine which patterns are associated with bladder and bowel symptoms in adolescence.
Design: Prospective cohort study.
Setting: General community.
Participants: The starting sample included 8,751 children (4,507 males, 4,244 females) with parent-reported data on frequency of bedwetting and daytime wetting for at least three of five time points (41/2, 51/2, 61/2, 71/2 and 91/2 years – hereafter referred to as 4 – 9 years). Study children provided data on a range of bladder and bowel symptoms at age 14 (data available for 5,899 participants).
Outcome measures: Self-reported bladder and bowel symptoms at 14 years including daytime wetting, bedwetting, nocturia, urgency, frequent urination, low voided volume, voiding postponement, passing hard stools and low stool frequency.
Results: We extracted five trajectories of urinary incontinence from 4 – 9 years using longitudinal latent class analysis: (i) normative development of daytime and nighttime bladder control (63.0% of the sample), (ii) delayed attainment of bladder control (8.6%), (iii) bedwetting alone (no daytime wetting) (15.6%), (iv) daytime wetting alone (no bedwetting) (5.8%), (v) persistent wetting (bedwetting with daytime wetting to age 9) (7.0%). The persistent wetting class generally showed the strongest associations with the adolescent bladder and bowel symptoms: odds ratio (OR) for bedwetting at 14 years = 23.5, 95% confidence interval (CI) (15.1, 36.5)], daytime wetting [6.98 (4.50, 10.8)], nocturia [2.39 (1.79, 3.20)], urgency [2.10 (1.44, 3.07)] and passing hard stools [2.64 (1.63, 4.27)] (reference category= normative development). The association with adolescent bedwetting was weaker for children with bedwetting alone [3.69 (2.21, 6.17)].
Conclusions: Trajectories of childhood urinary incontinence are differentially associated with adolescent bladder and bowel symptoms. Children exhibiting persistent bedwetting with daytime wetting had the poorest outcomes in adolescence.
Original languageEnglish
Article numbere014238
Number of pages10
JournalBMJ Open
Volume7
Issue number3
Early online date14 Mar 2017
DOIs
Publication statusPublished - Mar 2017

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