title: Non-biological determinants of paediatric bladder bowel dysfunction: A pilot study.
abstract: OBJECTIVE
  Children with bladder and bowel dysfunction (BBD) constitute a significant proportion of referrals at paediatric urology clinics worldwide, presenting with a wide range of symptom severity that may significantly affect quality of life. Non-biological factors may play a key role in triggering BBD severity, but these underpinning causes of BBD during childhood are still unknown. The aim of this study was to identify the effects of personal, family related and environmental variables on the severity of BBD symptoms in school-aged children.
  
  
  METHODS
  A pilot, prospective, observational study was conducted on 53 children diagnosed with BBD, and their legal guardian(s), on their first referred visit to a paediatric BBD clinic led by nurse practitioners. Upon receiving consent, patients and their legal guardian(s) completed three study questionnaires, with the guidance of research coordinators. The first questionnaire was the Dysfunctional Voiding Scoring System (DVSS); the second, a three-part questionnaire used to collect demographic information and data on the patient, their family and environmental characteristics; and the third gathered a detailed history of the child's lifestyle regimen, focusing on their bowel and bladder function.
  
  
  RESULTS
  Most of the children were female (66%), with an average age of 8.35 years. Most children attended public schools (74%) and none reported failing a grade. The mean parental age was 41.4 years (SD = 4.9 years), 62% of the families had two children and 53% were Caucasian. The mean DVSS score for this sample was 9.9 (SD = 4.2, range 2-21). Daycare attendance, school problems and unplanned pregnancy showed statistically significant influences on the severity of BBD and were associated with higher DVSS scores according to the Table below.
  
  
  CONCLUSIONS
  Children with BBD attending urology outpatient clinics as new referrals had more severe symptoms when they were born from an unplanned pregnancy, attended daycare and/or had school problems. These findings suggest that interventions aimed at decreasing BBD severity, or preventing its onset in school-aged children, should focus on the environment surrounding them, specifically on the interaction between personal, familial and environmental factors. These factors seem to have an important effect on paediatric continence, as children grow and develop under numerous societal influences and social interactions.
authors.affiliation: Division of Urology, The Hospital for Sick Children (Sick Kids Hospital(®)), 555 University Ave, Toronto, Ontario, M5G 1X8, Canada; Department of Nursing, Faculty of Health Sciences, University of Brasilia, SQN 214, Bloco K, Suite 613, Brasilia, Federal District, 70873-110, Brazil. Electronic address: martinsgise@gmail.com.
authors.forename: G
authors.initials: G
authors.lastname: Martins
authors.affiliation: Division of Urology, The Hospital for Sick Children (Sick Kids Hospital(®)), 555 University Ave, Toronto, Ontario, M5G 1X8, Canada. Electronic address: jeffreyminuk@gmail.com.
authors.forename: J
authors.initials: J
authors.lastname: Minuk
authors.affiliation: Division of Urology, The Hospital for Sick Children (Sick Kids Hospital(®)), 555 University Ave, Toronto, Ontario, M5G 1X8, Canada. Electronic address: abby.varghese@sickkids.ca.
authors.forename: A
authors.initials: A
authors.lastname: Varghese
authors.affiliation: London Health Sciences Centre (LHSC), Pediatric Urology, Victoria Hospital, 800 Commissioners Road East, London, Ontario, N6A 4G5, Canada. Electronic address: Sumit.Dave@lhsc.on.ca.
authors.forename: S
authors.initials: S
authors.lastname: Dave
authors.affiliation: Division of Urology, The Hospital for Sick Children (Sick Kids Hospital(®)), 555 University Ave, Toronto, Ontario, M5G 1X8, Canada. Electronic address: katharine.williams@sickkids.ca.
authors.forename: K
authors.initials: K
authors.lastname: Williams
authors.affiliation: Division of Urology, The Hospital for Sick Children (Sick Kids Hospital(®)), 555 University Ave, Toronto, Ontario, M5G 1X8, Canada. Electronic address: walid.farhat@sickkids.ca.
authors.forename: W A
authors.initials: WA
authors.lastname: Farhat
mesh_terms: D000328:Adult; D002648:Child; D003248:Constipation / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D003672:Defecation / Q000502:physiology; D005260:Female; D006801:Humans; D010865:Pilot Projects; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D012017:Referral and Consultation; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D001743:Urinary Bladder; D001745:Urinary Bladder Diseases / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D014554:Urination / Q000502:physiology
keywords: Children; Family; Lower urinary tract symptoms; Social environment