Behavioural problems in children with urge incontinence and voiding postponement: a comparison of a paediatric and child psychiatric sample

Abstract

OBJECTIVE; To analyse prospectively the incidence of behavioural disorders and the subjective views of children with urge incontinence (defined by detrusor instability, sudden urge symptoms and frequent micturitions) and voiding postponement (characterized by delayed micturition in typical situations and a low voiding frequency) according to an identical protocol in a paediatric and a child psychiatric unit.

Patients and method: Ninety-four consecutive or randomly selected children aged 5.0-10.9 years with either voiding postponement (52) or urge incontinence (42) were examined prospectively using an intelligence test (CFT1 or CFT20), the Child Behaviour Checklist (CBCL 4/18), the ICD-10 child psychiatric diagnoses and a structured interview.

Results: In the groups from both centres combined, those postponing voiding had a significantly higher incidence of externalizing behavioural symptoms (31% vs. 8%; P < 0.01) and total problems (37% vs. 13%; P < 0.05) in the clinical range (CBCL), and a higher rate of at least one ICD-10 child psychiatric diagnosis (54% vs. 29% P < 0.05) and of expansive disorders (31% vs. 5%; P < 0.01). The incidence of children with behavioural symptoms was lower in the paediatric centre, being exceptionally low among urge incontinent children (only 6%, CBCL). In contrast, from the children's subjective appraisal, there were no significant differences in concepts, explanations and implications of wetting; 79% of urge incontinent children and 64% of those postponing voiding suffered emotionally from the adverse effects of wetting. Only a minority (3% vs. 6%) saw any advantages at all.

Conclusion: Children with voiding postponement had a significantly higher incidence of behavioural problems, especially expansive/externalizing behaviour, 3-4 times higher than in the normal population. Children with urge incontinence had a significantly lower incidence of behavioural problems, mainly emotional/ internalizing behaviour, that was only slightly higher (1-2 times) than that in the normal population. Because of selection, similar trends but lower incidences were found in the paediatric setting, with very few problems among urge incontinent children. In contrast, the children's subjective views did not differ; disadvantages associated with emotional suffering were reported by all children.