Practical tips for paediatricians: Assessment and management of bladder and bowel dysfunction in the office

Abstract

Bladder and bowel dysfunction (BBD) is a term used to describe a spectrum of lower urinary tract symptoms (LUTS) and associated bowel complaints (constipation and/or encopresis) (1). It is a common, but under-recognized problem encountered by general paediatricians. Most cases are due to functional voiding disorders and constipation, rather than secondary or organic causes (1). BBD symptoms can negatively impact a child’s quality of life; thus, timely diagnosis and management are essential. Begin by obtaining a detailed clinical history of voiding routines, LUTS (i.e., frequency, dysuria, and enuresis), and prior urinary tract infections (UTI). Recognize overactive bladder symptoms including incontinence, urinary urgency, and holding manoeuvres (i.e., crossing of legs) (1). Requesting and reviewing voiding and bowel diaries (48 to 72 hours duration), a Bristol Stool Scale, and fluid/dietary intake can help to objectively identify patterns of BBD symptoms (1). Be aware of red flags that may suggest an underlying organic cause (Table 1). As there is a known association between BBD and neuropsychiatric disorders (i.e., anxiety, hyperactivity) (2), it is important to inquire about behaviour difficulties. Social history of recent life stressors and screening for sexual abuse should be considered.