title: The frequency of constipation in children with nocturnal enuresis: a comparison with parental reporting.
abstract: OBJECTIVE
  To identify the prevalence of constipation in children with nocturnal enuresis presenting to a tertiary paediatric outpatient service and to assess parental and clinician recognition of constipation.
  
  
  METHODS
  A prospective cross-sectional study of children with nocturnal enuresis at presentation to a continence service. Data relating to the child's bowel habits, pattern of enuresis and other history items were obtained from parental questionnaires and paediatrician assessments. Presence and severity of constipation was assessed independently by parents and clinicians. Kappa was used to compare agreement between parental reporting and clinician assessment of constipation.
  
  
  RESULTS
  Of the 277 participants aged 4.8-17.5 years (median 8.6 years), 36.1% (n = 95) were identified as constipated by the clinician-based scoring method ('Constipation Score') compared with 14.1% from parental reporting (Kappa = 0.155, P = 0.003). Despite the poor overall recognition of constipation by parents, parental and clinician assessment of frequency of bowel motions (Kappa = 0.804) and soiling (Kappa = 0.384) were similar. Major factors influencing parental reporting of constipation were frequency of bowel motions and soiling with less emphasis on straining and stool consistency.
  
  
  CONCLUSIONS
  Prevalence of constipation was high among children with nocturnal enuresis as assessed by clinicians despite poor identification by parents. This may limit optimal diagnosis and management.
authors.affiliation: Graduate Medical Program, University of Sydney, The Children's Hospital at Westmead Clinical School, Westmead, New South Wales, Australia.
authors.forename: Kathleen H
authors.initials: KH
authors.lastname: McGrath
authors.forename: Patrina H Y
authors.initials: PH
authors.lastname: Caldwell
authors.forename: Michael P
authors.initials: MP
authors.lastname: Jones
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003248:Constipation / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D008297:Male; D009517:New South Wales / Q000453:epidemiology; D053206:Nocturnal Enuresis / Q000150:complications* / Q000453:epidemiology*; D010290:Parents; D010372:Pediatrics; D015995:Prevalence; D011446:Prospective Studies; D012720:Severity of Illness Index; D017678:Sex Distribution; D011795:Surveys and Questionnaires