Review Article | Published:

Urinary incontinence in children with special needs

Nature Reviews Urology volume 10, pages 667674 (2013) | Download Citation

Abstract

Nocturnal enuresis, daytime urinary incontinence, lower urinary tract symptoms and faecal incontinence are more common in children with special needs than in typically developing children. Children with intellectual disability, which can be attributed to a range of causes, are particularly affected. Indeed, the epidemiological and clinical studies conducted to date show clear associations that children with special needs have higher rates of urinary (and faecal) incontinence than children without development, physical or cognitive impairments. For example, low intelligence quotient (IQ)-associated physical disability and conditions such as Fragile X and Rett syndromes increase the risk for incontinence, which can persist into adulthood if left untreated. Although the association of attention deficit hyperactivity disorder and incontinence has been shown in many studies, further research is needed on other specific disorders, such as autism. As many children are not receiving adequate care, specific multimodal treatments based on rigorous assessment of the incontinence, underlying condition and associated comorbid disorders should be actively offered.

Key points

  • Children with special needs have higher rates of all types of incontinence than children without developmental or behavioural impairments; children with specific syndromes, such as Fragile X and Rett syndromes, are particularly affected

  • Intellectual disability—an intelligence quotient (IQ) <70—is a major risk factor for incontinence, with increasing rates as IQ decreases; lower urinary tract symptoms, overactive bladder, dysfunctional voiding and low fluid intake are also typical

  • In children with physical disability, organic and functional types of incontinence can overlap

  • Although attention deficit hyperactivity disorder and incontinence are clearly associated, further research on other conditions (such as autism) is required

  • Assessment and treatment of incontinence should be offered actively to children with special needs using multimodal urological, paediatric and child psychiatric care

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Affiliations

  1. Department of Child and Adolescent Psychiatry, Saarland University Hospital, 66421 Homburg, Germany.  alexander.von.gontard@uks.eu

    • Alexander von Gontard

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The author declares no competing financial interests.

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DOI

https://doi.org/10.1038/nrurol.2013.213

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