The wider impact of child bed-wetting

Important factors affecting the quality of life of Australian school children with urinary incontinence have been identified, Linda Belardi reports.

Children with incontinence from non-Caucasian backgrounds are at higher risk of experiencing severe negative effects on their wellbeing, research has found.

The NSW study of 140 children aged between six and 16 has drawn attention to the influence of cultural values, age and gender in shaping the experience and quality of life of children due to bladder-related problems.

Dr Aniruddh Deshpande, research fellow in urology with the Centre for Kidney Research, said the findings emphasised the need for greater support for children with urinary incontinence, particularly those with a diverse ethnicity.

These findings add to an emerging body of evidence which shows that the quality of life of children may not be dependent only on the disease itself but on cultural, socio-economic and possibly cognitive characteristics of the child.

While the surveyed children had similar socio-economic backgrounds, those of Asian and Middle Eastern origin reported significantly lower personal wellbeing.

Dr Deshpande from the Children's Hospital at Westmead said this may be due to cultural differences in how families respond to wetting in children beyond the age of five. For example, cultural practices in South Asia mean that children are toilet trained at a much earlier age.

As Australia becomes a more multicultural population, the differential effect of urinary incontinence on the quality of life of the child is something that all clinicians need to be well aware of."

About 10 to 15 per cent of the study cohort was from a non-Caucasian background, predominantly the Middle East. He said clinicians could not adopt the same approach when dealing with the diverse treatment needs of patients.

In addition to the influence of culture, the study also reported for the first time that girls were consistently more worried about their condition than boys. As children grew older their quality of life also worsened, despite a reduction in the severity of their symptoms.

Deshpande said while children experienced reduced amounts of urinary leakage with age, older children required more psychological support to manage their higher psychological distress. "The fact that older children were more severely affected by their incontinence is somewhat intuitive since older children tend to have bigger identities and are more able to express themselves."

To best target children identified as "high risk", non-Caucasian children and older girls, in particular, required greater access to psychological support, family education and family counselling.

Deshpande said it was surprising that all the factors that most strongly influenced a child's quality of life were non-modifiable, with age, gender and ethnicity playing the biggest role. The study clearly reported that the impact of incontinence on a child's life was not correlated with the severity of the condition.

"Although not often recognised by parents or clinicians, even mild urinary incontinence can have a significant impact on the quality of life in affected children," he said. "Whether a child experienced minor or major amounts of urinary leakage that was unrelated to how strongly a child worried about their condition."

"It would be a mistake based on this study to assume that minor symptoms of incontinence, which may diminish with time, do not require medical or allied health support," said Deshpande. It is estimated that approximately one third of all children who bed wet do not see a doctor for their condition.

The study also showed that the mental health impacts of urinary incontinence were significant and can't be ignored. Incontinence is a significant source of anxiety for both children and families.

In an assessment of the impact of urinary incontinence on a child's life, the two domains perceived to be most affected were self-esteem and mental health.

"The psychological impact of urinary incontinence if neglected could evolve into a major problem for children," he said.

Children with other major illnesses, such as heart or kidney, were also just as likely to be negatively affected by urinary incontinence as healthy children. The presence of additional chronic disease did not dilute the impact that wetting had on their quality of life, demonstrating the high impact of urinary incontinence - however minor - on overall wellbeing, said Deshpande.

It is estimated that urinary incontinence affects between 5 and 15 per cent of school-age children.

However, very little is known about how children perceive the disease.

Deshpande said this study has stressed the importance of shifting to a more child-centric treatment model. The traditional model has focused on parents and the doctors combining to decide what was best for the child, he said.

The Children's Hospital at Westmead is currently seeking to increase the use of counselling for children with urinary incontinence and to share the findings with other clinics as part of a collaborative service for the condition. The study's findings were published in the September edition of the Journal of Urology.

Factors that strongly influence the impact of urinary incontinence in children
* Being female
* Older age
* Non-Caucasian background

Factors that don't impact
* Severity of the condition
* Overall health status

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