DEFECATION DISORDERS AND URINARY INCONTINENCE IN NEUROLOGICALLY NORMAL CHILDREN‐‘FUNCTIONAL ELIMINATION DISORDER’?.

Aims: The association between defecation disorders and functional incontinence was first described in 1964, and became known as ‘elimination disorder’. A number of reports appeared describing retrospectively the favourable effect on incontinence of treatment of solely the defecation disorder. We prospectively studied the reverse, by following the prevalence of defecation disorders in neurologically normal children with urge syndrome or dysfunctional voiding, treated for urinary incontinence. Methods: Children with functional incontinence have been studied prospectively in the European Bladder dysfunction study (EBDS). All children received urinary incontinence therapy. Validated questionnaires on bladder function and on bowel habits, were filled out at enrollment and after treatment. Symptoms of defecation disorders were a defecation frequency <3 per week, or painful defecation, alone or in combination with soiling and/or encopresis; No therapy for defecation disorders was started during the study, but whenever such therapy had been started before enrollment, it was continued. Results: 179 children with functional incontinence who completed the study, filled out the questionnaire on constipation at entry and after 6 months of therapy, and are available for current analysis. At entry, 6 children have a low defecation frequency (2/6 combined with fecal soiling), and 11 have painful defecation (4/11 combined with fecal soiling); 8 children have encopresis (8/8 combined with fecal soiling), and 49 have isolated fecal soiling. After treatment for urinary incontinence, the prevalence for soiling drops (from 63 to 40). For encopresis, low defecation frequency and painful defecation, differences in prevalence before and after treatment are too small to be statistically significant. The outcome on urinary incontinence in the presence of defecation disorders is the same as in the absence of defecation disorders, and is independent of the resolution of defecation disorders. Conclusions: With the treatment plans for incontinence, overall prevalence of defecation disorders dropped from 41% at entry to 29% after treatment. However, this change is not dependent on the outcome of incontinence treatment. We could find no arguments for a reciprocal relation between defecation disorders and functional incontinence.