Influence of Delayed Elimination Communication on the Prevalence of Bladder and Bowel Dysfunction in Children aged 2-8 of China

Xu P1, Wen J1, He Y1, Wen Y1, Chen Y1, Wang Y2, Li Y2, Feng J2, He X2, Wang X2, Jorgensen C3

Research Type


Abstract Category

Prevention and Public Health

Abstract 403
E-Poster 2
Scientific Open Discussion Session 18
Thursday 5th September 2019
13:50 - 13:55 (ePoster Station 11)
Exhibition Hall
Pediatrics Questionnaire Voiding Dysfunction Bowel Evacuation Dysfunction
1.Pediatric Urodynamic Center,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan Province,China, 2.Key-Disciplines Laboratory Clinical-Medicine Henan,Zhengzhou, Henan Province,China, 3.Department of Urology,Aarhus University, Denmark

PengChao Xu




Hypothesis / aims of study
To determine the prevalence of bladder bowel dysfunction( BBD) and its relationship to delayed elimination communication (EC) in children in  Mainland China.
Study design, materials and methods
From March to November 2018,a cross-sectional study was carried out at 19 kindergartens and 18 primary schools in 12 cities distributed through the four main regions of Mainland China, with anonymous self-administered questionnaires survey which addressed non-neuropathic pediatric BBD. The epidemiological survey performed in the cities was with high population density located throughout Mainland China like Shenzhen(South), Xiamen(Southeast), Zhengzhou(Middle), Xi'an(West) and Harbin(North),etc. Before the investigation, the study protocol was approved by the Chinese Ethics Committee to protect the privacy of the children surveyed, then we administered a previously published validated BBD questionnaire presented to the pediatric institutions, the number of individuals surveyed per school was more than 200.The cross-sectional paper survey used a self-administered anonymous questionnaire filled by children and their caregivers. To ensure the accuracy of the questionnaire, the investigators were specially trained in advance, with whose guidance the questionnaires were filled out by the caregivers. A total of 10587children with ages ranging from 2-8 years were involved in this study. The main contents of the questionnaire include: ①general information (gender, age, height, weight, date of birth, etc.)②using condition of DD after birth (whether DD is used, length of use, number of pieces per day, and whether there are untoward effect, etc.) ③Time of elimination communication (EC) initiation (including potting training, assistant infant’s toilet training)starting time.④current voiding and defecation status, whether to meet the BBD diagnostic criteria.⑤whether or not there is an organic disease that affects urination and defecation. The inclusion criteria of the study were the ones aged 2-8, with functional DUI and/or enuresis and coexisting constipation and/or faecal incontinence. The standard of BBD was defined as the suggestions of ICCS in 2013, used to describe children with a combination of functional bladder and bowel disturbances. It is diagnosed according to the ICD-10 and DSM-V. Meanwhile, the exclusion criteria were children with neuropathic or anatomical abnormalities in the urinary tract or gastrointestinal canal, who were ongoing treatment with anticholinergics, food allergies, inflammatory bowel disease,or any other disorder affecting bladder or bowel function. Children primarily referred with recurrent UTIs were not included in the study.
Besides,definition of children's BBD: children present with lower urinary tract symptoms and defecation dysfunction together, mainly manifested as urinary frequency, urgency, incontinence (sometimes enuresis, droppings, contaminated feces), dysuria, repeated urinary tract infections, constipation or diarrhea, etc. , clinically no evidence of neurological and anatomical organic diseases[1,2,3].SPSS 21.0 statistical software was used for statistical analysis. The quantitative data of the normal distribution were expressed byx±s, and χ2 tests were used to determine significant differences in prevalence of BBD among all youth at different age groups.The mean between groups was compared by t-test and analysis of variance. Multivariate analysis of the incidence of BBD using logistic regression.
① A total of 8026 valid questionnaires were collected, with 4027 males and 3999 females, of which 219 ones were diagnosed with BBD ,the overall prevalence was 2.73%.②Among the children aged 2-8 years surveyed, the prevalence decreased with age, from 4.89% at age 2 to 0.85% at 8(P <0.001) .③Totally, 108 of the 4,027 boys had BBD, the prevalence was 2.68%.④ A total of 111 of 3,999 girls were diagnosed with BBD , the prevalence was 2.78%. ⑤No gender difference existed(P>0.05).⑥When the onset time of EC was significantly delayed (=71.350,P <0.001), the prevalence of BBD increased (=21.613,P <0.001). ⑦The prevalence of BBD in the children who started EC in 12 months since birth and the individuals who never had EC was 0.62% and 16.51%, respectively.⑧ Logistic regression and multi-factor analysis showed that starting EC within 12 months since birth was the protective factor for BBD (OR<1).
Interpretation of results
The prevalence of BBD gradually decreases with age, but,the time to initiate EC or toilet training is delayed with the popular use of DD, resulting in the actual practice of missing children’s early learning self-controlled urination and feces as soon as possible, as well as an increase in the prevalence of BBD.
Concluding message
BBD prevalence increased significantly during the last few years in Mainland China. Starting EC within 12 months since birth and less use of DD were helpful  in preventing the occurrence of BBD in children.
Figure 1
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  1. Austin PF, Bauer SB, Bower W,et al. The standardization of terminology of lower urinary tract function in children and adolescents: update report from the Standardization Committee of the International Children’s Continence Society[J].Neurourol Urodyn. 2016 ;35:471-481. DOI: 10.1002/nau.22751.
  2. Borch L, Hagstroem S, Bower W F, et al. Bladder and bowel dysfunction and the resolution of urinary incontinence with successful management of bowel symptoms in children[J]. Acta Paediatrica, 2013, 102(5):e215-e220.DOI:10.1111/apa.12158.
  3. Von Gontard A , Baeyens D , Van Hoecke E , et al. Psychological and Psychiatric Issues in Urinary and Fecal Incontinence[J]. The Journal of Urology, 2011, 185(4):1432-1437.DOI:10.1016/j.juro.2010.11.051.
Funding Henan Provincial International Cooperation Project , No: 182102410002 Clinical Trial No Subjects Human Ethics Committee Ethical committee of First Afilliated Hospital of Zhengzhou University Helsinki Yes Informed Consent Yes
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