title: Bladder and bowel dysfunctions in 1748 children referred to pelvic physiotherapy: clinical characteristics and locomotor problems in primary, secondary, and tertiary healthcare settings.
abstract: The aims of this study are to evaluate in a pragmatic cross-sectional study, the clinical characteristics of childhood bladder and/or bowel dysfunctions (CBBD) and locomotor problems in the primary through tertiary health care setting. It was hypothesized that problems would increase, going from primary to tertiary healthcare. Data were retrieved from patient-records of children (1-16 years) presenting with CBBD and visiting pelvic physiotherapists. Prevalence's of dysfunctions were compared between healthcare settings and gender using ANOVA and chi-square test. Agreement between physicians' diagnoses and parent-reported symptoms was evaluated (Cohen's Kappa). One thousand seventy hundred forty-eight children (mean age 7.7 years [SD 2.9], 48.9% boys) were included. Daytime urinary incontinence (P = 0.039) and enuresis (P < 0.001) were more diagnosed in primary healthcare, whereas constipation (P < 0.001) and abdominal pain (P = 0.009) increased from primary to tertiary healthcare. All parent-reported symptoms occurred more frequently than indicated by the physicians. Poor agreement between physicians' diagnoses and parent-reported symptoms was found (k = 0.16). Locomotor problems prevailed in all healthcare settings, motor skills (P = 0.041) and core stability (P = 0.015) significantly more in tertiary healthcare.
  
  
  CONCLUSIONS
  Constipation and abdominal pain (physicians' diagnoses) and the parent-reported symptoms hard stools and bloating increased from primary to tertiary healthcare. Discrepancies exist between the prevalence's of physicians' diagnoses and parent-reported symptoms. Locomotor problems predominate in all healthcare settings. What is Known: • Childhood bladder and/or bowel dysfunctions (CCBD) are common. • Particularly tertiary healthcare characteristics of CBBD are available What is New: • Characteristics of CBBD referred to pelvic physiotherapy are comparable in primary, secondary, and tertiary healthcare settings. • Concomitant CBBD appeared to be more prevalent than earlier reported. • Discrepancies exist between referring physicians' diagnoses and parent-reported symptoms.
authors.affiliation: Department of Epidemiology, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), PO Box 616, 6200 MD, Maastricht, the Netherlands. m.vanengelenburg@maastrichtuniversity.nl.
authors.forename: Marieke L
authors.initials: ML
authors.lastname: van Engelenburg-van Lonkhuyzen
authors.affiliation: Department of Epidemiology, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), PO Box 616, 6200 MD, Maastricht, the Netherlands.
authors.forename: Esther M J
authors.initials: EM
authors.lastname: Bols
authors.affiliation: Department of Paediatric Gastroenterology, Emma Children's Hospital/Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Benninga
authors.affiliation: Zuwe Hofpoort Ziekenhuis, Polanerbaan 2, 3447 GN, Woerden, the Netherlands.
authors.forename: Wim A
authors.initials: WA
authors.lastname: Verwijs
authors.affiliation: Department of Epidemiology, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), PO Box 616, 6200 MD, Maastricht, the Netherlands.
authors.forename: Rob A
authors.initials: RA
authors.lastname: de Bie
mesh_terms: D015746:Abdominal Pain / Q000453:epidemiology; D000293:Adolescent; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003248:Constipation / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005242:Fecal Incontinence / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009048:Motor Skills; D009426:Netherlands / Q000453:epidemiology; D010290:Parents; D026741:Physical Therapy Modalities; D011320:Primary Health Care / Q000706:statistics & numerical data*; D063127:Secondary Health Care / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D063189:Symptom Assessment; D063128:Tertiary Health Care / Q000706:statistics & numerical data*; D014555:Urination Disorders / Q000453:epidemiology*
keywords: Constipation; Enuresis; Incontinence; Motor control; Pelvic floor muscles; Questionnaire