title: Bladder and bowel dysfunction: evidence for multidisciplinary care.
abstract: OBJECTIVE
  We examined the symptoms of bladder-bowel dysfunction (ie severity of voiding dysfunction and stool consistency) and psychosocial difficulties in children presenting to the pediatric urology clinic for voiding dysfunction and to the pediatric gastroenterology clinic for functional constipation.
  
  
  METHODS
  Parents of children seen at the gastroenterology clinic were recruited during the outpatient clinic appointment, and parents of children seen at the urology clinic were randomly selected from the research database and matched to the gastroenterology sample based on age and gender of the child. All parents completed the Dysfunctional Voiding Scoring System, Bristol Stool Form Scale, Pediatric Symptom Checklist and Parenting Stress Index™-Short Form, which assessed severity of voiding dysfunction, stool consistency, level of psychosocial difficulties and level of parenting stress, respectively.
  
  
  RESULTS
  Children seen at the urology and gastroenterology clinics did not differ significantly on any of the measures, indicating that the severity of their bladder-bowel dysfunction is similar. However, they had significantly more severe voiding dysfunction, more constipated stool and more psychosocial difficulties than historical healthy controls. Additionally, level of parenting stress was significantly correlated with patient level of psychosocial difficulties and severity of voiding dysfunction.
  
  
  CONCLUSIONS
  Patients with bladder and bowel dysfunction represent a homogeneous group that would potentially benefit from a multidisciplinary treatment approach involving urology, gastroenterology and psychology professionals.
authors.affiliation: Department of Pediatric Urology, Children's Hospital of Michigan, Detroit, Michigan. Electronic address: cbwolfe@dmc.org.
authors.forename: Cortney
authors.initials: C
authors.lastname: Wolfe-Christensen
authors.forename: Alexandra
authors.initials: A
authors.lastname: Manolis
authors.forename: William C
authors.initials: WC
authors.lastname: Guy
authors.forename: Natalija
authors.initials: N
authors.lastname: Kovacevic
authors.forename: Najeeb
authors.initials: N
authors.lastname: Zoubi
authors.forename: Mohammad
authors.initials: M
authors.lastname: El-Baba
authors.forename: Larisa G
authors.initials: LG
authors.lastname: Kovacevic
authors.forename: Yegappan
authors.initials: Y
authors.lastname: Lakshmanan
mesh_terms: D002648:Child; D003248:Constipation / Q000523:psychology* / Q000628:therapy*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D010348:Patient Care Team; D001745:Urinary Bladder Diseases / Q000523:psychology* / Q000628:therapy*
keywords: BSFS; Bristol Stool Form Scale; DVSS; Dysfunctional Voiding Scoring System; GI; PSC; PSI-SF; Parenting Stress Index-Short Form; Pediatric Symptom Checklist; combined modality therapy; constipation; gastroenterology; urinary incontinence