title: Giggle incontinence in children: a manifestation of detrusor instability.
abstract: OBJECTIVE
  To our knowledge the prevalence and cause of giggle incontinence in children is not known. We hypothesized that laughter may induce unstable detrusor contractions in children susceptible to detrusor instability. We evaluated the prevalence of diurnal voiding symptoms of urinary urgency, urge incontinence, pelvic withholding maneuvers and hesitancy in patients with giggle incontinence, the prevalence of giggle incontinence in patients with diurnal voiding symptoms, the prevalence of the 2 conditions in first degree relatives of patients with giggle incontinence, the influence of treatment for detrusor instability on the frequency of giggle incontinence and the prevalence of diurnal voiding symptoms in control children with giggle incontinence.
  
  
  METHODS
  Of 1,421 children 5 to 15 years old referred to the pediatric nephrology department for various problems 109 were diagnosed with giggle incontinence and 460 had diurnal voiding symptoms. A total of 627 children visiting the pediatrician office whose parents completed a survey questionnaire served as controls.
  
  
  RESULTS
  Diurnal voiding symptoms were noted in 95% of the patients with giggle incontinence, while giggle incontinence was noted in 23% of those with diurnal voiding symptoms. Of the patients with giggle incontinence a positive family history for that entity and diurnal voiding symptoms was noted in 13% and 28%, respectively. Giggle incontinence improved in all patients after treatment for detrusor instability and it resolved completely in 89%. Giggle incontinence recurred with a relapse of diurnal voiding symptoms in 28 cases and improved with improved diurnal voiding symptoms during modification of therapy. Diurnal voiding symptoms were present in 43% of the 157 controls with giggle incontinence.
  
  
  CONCLUSIONS
  Giggle incontinence results from detrusor instability induced by laughter and it improves with effective treatment of detrusor instability.
authors.affiliation: Division of Pediatric Nephrology, Schneider Children's Hospital at North Shore, New York, USA.
authors.forename: Manju
authors.initials: M
authors.lastname: Chandra
authors.forename: Reeta
authors.initials: R
authors.lastname: Saharia
authors.forename: Qiuhu
authors.initials: Q
authors.lastname: Shi
authors.forename: Vanessa
authors.initials: V
authors.lastname: Hill
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D020022:Genetic Predisposition to Disease / Q000235:genetics; D006801:Humans; D015994:Incidence; D007845:Laughter / Q000502:physiology*; D008297:Male; D009122:Muscle Hypertonia / Q000175:diagnosis / Q000235:genetics / Q000503:physiopathology*; D012307:Risk Factors; D014550:Urinary Incontinence, Stress / Q000209:etiology / Q000235:genetics / Q000503:physiopathology*; D014563:Urodynamics / Q000502:physiology