title: Phantom urinary incontinence in children with bladder-bowel dysfunction.
abstract: OBJECTIVE
  To report a previously undescribed condition in which children present with the sensation of wetness because of presumed urinary incontinence when they are actually completely dry. We have termed this entity "phantom" urinary incontinence (PUI).
  
  
  METHODS
  Twenty children referred to our pediatric urology clinic were diagnosed with PUI between 2009 and 2013. Patient demographics, associated bladder and bowel symptoms, concomitant diagnoses, imaging, management, and treatment outcomes were evaluated.
  
  
  RESULTS
  Twenty children (18 females and 2 males) were diagnosed with PUI over a 5-year interval. Mean age at diagnosis was 6.9 ± 2.5 years (range, 4-12 years). Nineteen patients (95%) had concomitant lower urinary tract symptoms, and all were also diagnosed with constipation. Urgency (75%) and frequency (50%) were the most common associated bladder symptoms. Of the 18 girls, 13 (72%) had associated vaginitis. Fourteen children (70%) carried a parent-reported diagnosis of obsessive-compulsive disorder or obsessive-compulsive disorder personality traits. Patients were managed with timed voiding, dietary modifications, and a bowel regimen. Ninety percent children experienced improvement of bladder-bowel dysfunction and resolution of PUI at a mean follow-up of 14.4 months.
  
  
  CONCLUSIONS
  Children with PUI have a high incidence of obsessive-compulsive traits. Phantom incontinence as well as associated lower urinary tract symptoms resolve with adherence to a strict bladder-bowel regimen.
authors.affiliation: Department of Pediatric Urology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA.
authors.forename: Angela M
authors.initials: AM
authors.lastname: Arlen
authors.affiliation: Department of Pediatric Urology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA.
authors.forename: Liisa L
authors.initials: LL
authors.lastname: Dewhurst
authors.affiliation: Department of Psychiatry, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA.
authors.forename: Susan S
authors.initials: SS
authors.lastname: Kirsch
authors.affiliation: Department of Psychiatry, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA.
authors.forename: Arden D
authors.initials: AD
authors.lastname: Dingle
authors.affiliation: Department of Pediatric Urology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA.
authors.forename: Hal C
authors.initials: HC
authors.lastname: Scherz
authors.affiliation: Department of Pediatric Urology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA. Electronic address: akirschmd@gmail.com.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Kirsch
mesh_terms: D002648:Child; D002675:Child, Preschool; D004775:Enuresis / Q000150:complications / Q000523:psychology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000150:complications; D012002:Rectal Diseases / Q000150:complications / Q000523:psychology*; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000473:pathology; D014549:Urinary Incontinence / Q000150:complications / Q000523:psychology*