American Academy of Pediatrics Section on Urology

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Released January 4, 2022

Do not treat urinary incontinence in a child with pharmacotherapy (e.g., anticholinergics), before first evaluating and treating constipation.

The association of lower urinary tract dysfunction and constipation is termed bladder-bowel dysfunction (BBD). From 25-30% of children with functional constipation have daytime urinary incontinence. Treatment of constipation alone can eliminate daytime urinary incontinence in many patients and also has been shown to reduce recurrent urinary tract infection. The clinical diagnosis of constipation can be made using the Rome IV criteria. Treatment strategies involve education, fecal disimpaction in many, prevention of re-accumulation with maintenance regimens and close follow-up.

If a child is started on anti-cholinergic medications, the bowel regimen must be continued to obviate worsening constipation.


These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The AAP Section on Urology (AAP SOU) Executive committee worked together to develop five items in the practice of Pediatric Urology of tests or procedures that should not be done routinely. Approximately 11 members of this committee participated in the process. They submitted items from their practices and experiences of tests or procedures they found were commonly over-utilized. The committee then agreed on a final list of 5 based on incidence and importance of the condition. Educational committee fellows then reviewed the appropriate guidelines and literature to provide references and support for each item. The AAP SOU Education committee reviewed the 5 listed items and provided further feedback then approved the list, descriptions, and references. The AAP Executive Committee granted final approval of the list.

AAP’s disclosure and conflict of interest policy can be found at www.aap.org.

Sources

Colombo, J. M., Wassom, M. C. & Rosen, J. M. Constipation and Encopresis in Childhood. Pediatr Rev 36, 392-401; quiz 402, doi:10.1542/pir.36-9-392 (2015).

van Summeren, J. J. G. T. et al. Bladder Symptoms in Children With Functional Constipation: A Systematic Review. J Pediatr Gastroenterol Nutr 67, 552-560, doi:10.1097/ MPG.0000000000002138 (2018)

Drossman, D. A. Functional Gastrointestinal Disorders: History, Pathophysiology, Clinical Features and Rome IV. Gastroenterology. 150 (6), 1262-1279.e2,doi:10.1053/j.gastro.2016.02.032 (2016)

Loening-Baucke, V. Functional fecal retention with encopresis in childhood. J Pediatr Gastroenterol Nutr 38, 79-84, doi:10.1097/00005176-200401000-00018 (2004).

Burgers, R. E. et al. Management of functional constipation in children with lower urinary tract symptoms: report from the Standardization Committee of the International Children’s Continence Society. J Urol 190, 29-36, doi:10.1016/j.juro.2013.01.001 (2013).