RCT of Bowel Management With or Without Standard Urotherapy in Pediatric BBD

Overview

This randomized clinical trial evaluated whether combining standard urotherapy (SU) with bowel management improves daytime urinary incontinence (DUI) compared to bowel management alone in children aged 5 to 14 years with bladder and bowel dysfunction (BBD). The study found that bowel management is essential and that adding SU may provide additional benefits in reducing DUI frequency and severity over 12 weeks.

Background

Bladder and bowel dysfunction (BBD) in children is characterized by functional constipation alongside lower urinary tract symptoms such as urgency, altered voiding frequency, and urinary incontinence. It affects up to 20% of children aged 7 years and is a common reason for pediatric urology referrals. BBD increases risks of urinary tract infections, kidney damage, and negatively impacts quality of life. Treatment guidelines recommend a stepwise approach prioritizing bowel management before urinary symptom-specific therapies, but high-quality evidence guiding optimal treatment sequencing is limited.

Data Highlights

Key Findings

• Bowel management alone significantly reduces daytime urinary incontinence in children with BBD.
• Adding standard urotherapy to bowel management results in greater reductions in the number of wet days per week.
• Children receiving combined therapy show higher rates of partial and complete response according to ICCS criteria.
• Incontinence severity scores improve more with combined therapy than with bowel management alone.
• Bowel function, assessed by Rome IV criteria and stool consistency, improves similarly in both groups.
• Bladder function parameters, including voiding frequency and maximum voided volume, improve more with combined therapy.

Clinical Implications

Clinicians should prioritize bowel management as the foundational treatment for pediatric patients with BBD. Incorporating standard urotherapy, including timed voiding and education on optimal toileting habits, can enhance treatment efficacy and further reduce urinary incontinence. Regular monitoring and tailored adjustments to bowel and bladder interventions are recommended to optimize outcomes.

Conclusion

This trial supports a stepwise treatment approach for pediatric BBD, demonstrating that bowel management effectively reduces urinary incontinence and that combining it with standard urotherapy provides additional clinical benefit. These findings provide higher-level evidence to guide treatment sequencing in this population.

References

1. International Children’s Continence Society (ICCS) Guidelines
2. European Society for Paediatric Gastroenterology, Hepatology, and Nutrition Guidelines
3. European Association of Urology and European Society of Paediatric Urology Recommendations