title: Dysfunctional elimination syndromes--how closely linked are constipation and encopresis with specific lower urinary tract conditions?
abstract: OBJECTIVE
  It is recognized that there is a strong association between bladder and bowel dysfunction. We determined the association of constipation and/or encopresis with specific lower urinary tract conditions.
  
  
  METHODS
  We reviewed our database of children with lower urinary tract dysfunction and divided cases into 3 categories of bowel dysfunction (constipation, encopresis and constipation plus encopresis) and 4 lower urinary tract conditions (dysfunctional voiding, idiopathic detrusor overactivity disorder, detrusor underutilization disorder and primary bladder neck dysfunction). Associations between bowel dysfunction types and each lower urinary tract condition were determined.
  
  
  RESULTS
  Of 163 males and 205 females with a mean age of 8.5 years constipation was the most common bowel dysfunction (27%). Although encopresis is generally thought to reflect underlying constipation, only half of children with encopresis in this series had constipation. Dysfunctional voiding was associated with the highest incidence of bowel dysfunction. All but 1 patient with encopresis had associated urgency and detrusor overactivity, and the encopresis resolved in 75% of patients after initiation of anticholinergic therapy. Constipation was significantly more common in girls (27%) than in boys (11%, p <0.01), while encopresis was more common in boys (9%) than in girls (3%, p = 0.02), likely reflecting the higher incidence of dysfunctional voiding in girls and idiopathic detrusor overactivity disorder in boys.
  
  
  CONCLUSIONS
  Active bowel dysfunction was seen in half of the children with a lower urinary tract condition. Constipation was more common in patients with dysfunctional voiding, while encopresis was significantly increased in those with idiopathic detrusor overactivity disorder and in those with dysfunctional voiding, severe urgency and detrusor overactivity. Anticholinergics, despite their constipating effect, given for treatment of detrusor overactivity resolved encopresis in most children with this bowel dysfunction.
authors.affiliation: Division of Pediatric Urology, Morgan Stanley Children's Hospital of New York-Presbyterian, Department of Urology, Columbia University, College of Physicians and Surgeons, New York, New York 10032, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Combs
authors.forename: Jason P
authors.initials: JP
authors.lastname: Van Batavia
authors.forename: Jennifer
authors.initials: J
authors.lastname: Chan
authors.forename: Kenneth I
authors.initials: KI
authors.lastname: Glassberg
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015897:Comorbidity; D003248:Constipation / Q000453:epidemiology* / Q000503:physiopathology; D016208:Databases, Factual; D004576:Electromyography / Q000379:methods; D004688:Encopresis / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D015994:Incidence; D059411:Lower Urinary Tract Symptoms / Q000453:epidemiology* / Q000503:physiopathology; D008297:Male; D011379:Prognosis; D011788:Quality of Life; D012189:Retrospective Studies; D012720:Severity of Illness Index; D017678:Sex Distribution; D013577:Syndrome; D001748:Urinary Bladder Neck Obstruction / Q000453:epidemiology / Q000503:physiopathology; D053201:Urinary Bladder, Overactive / Q000453:epidemiology / Q000503:physiopathology; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000503:physiopathology
keywords: DO; DUD; DV; EMG; IDOD; KUB; LUT; LUT dysfunction; LUTD; LUTS; PBND; UTI; constipation; detrusor overactivity; detrusor underutilization disorder; dysfunctional voiding; electromyography; encopresis; idiopathic detrusor overactivity disorder; lower urinary tract; lower urinary tract symptoms; plain x-ray of the kidneys, ureters and bladder; primary bladder neck dysfunction; urinary tract infection