A Population Based Study of 2,856 School-Age Children With Urinary Incontinence

Purpose:We estimated the spectrum and risk factors for daytime urinary incontinence in school-age children.Materials and Methods:A validated, reproducible, parent administered daytime incontinence questionnaire was distributed to randomly selected school children. The questionnaire elicited information on demographic factors, prenatal and developmental factors, and bowel and urinary history. The spectrum of daytime urinary incontinence was measured by recording the frequency and amount of incontinence.Results:Parents of 2,856 children (mean age 7.3 years) completed the questionnaire. Overall 16.9% reported any daytime urinary incontinence in the previous 6 months, with 64% of cases being very mild, 14.8% mild, 11.6% moderate and 9.6% severe. There was low agreement between frequency and amount of incontinence (weighted kappa 0.03) but risk factors were similar. Independent risk factors were nocturnal enuresis (OR 7.2, 95% CI 3.4 to 15.2), female gender (5.4, 2.6 to 11.1), social concerns (3.4, 1.4 to 8.3), urinary tract infection (5.6, 2.0 to 15.6) and encopresis (3.3, 1.4 to 7.7). Expressed as population attributable risk, 36% of moderate to severe daytime incontinence can be attributed to encopresis, nocturnal enuresis, social concerns, female gender or urinary tract infection. Urinary tract infection was a risk factor for boys but not for girls (interaction p <0.01).Conclusions: Daytime urinary incontinence in children is a common but heterogeneous disorder. Episodes may be frequent or major or both but appear to share the same causal pathway. Given the risk factors identified, interventions should target endogenous/physiological and environmental factors. Daytime urinary incontinence is a common condition, and affected children encounter problems with their social lives and self-esteem. 1,2 There is a wide variation in the prevalence reported in the literature, from 1.8% to 20%, which may reflect variable definitions and settings. 2–6 Generally severity of daytime urinary incontinence is described in terms of frequency only (daily, weekly, monthly etc). 2,3,5,7 Two studies have described the spectrum of daytime incontinence in terms of amount (small patch on underclothes, soaking of pants etc) 4,8 but only 1 study of 10 to 14-year-old school children in Belgium has measured frequency and amount of leakage. 9 Although common, the causes of daytime incontinence are relatively unknown. Identified risk factors include other symptoms of bladder dysfunction, constipation, fecal soiling, attention deficit hyperactivity disorder and urinary tract infection. 5–7,10,11 No studies have evaluated all of these factors together to determine which are independently contributory. The aims of this study were to determine the spectrum of daytime urinary incontinence, including frequency and amount, to measure agreement between both domains and to identify independent risk factors from a population based sample of school children to inform the development of effective intervention strategies.