Assessment and Validation of a new Questionnaire to evaluate and screen for Bladder and Bowel Dysfunction in Children
Taha Anwar, MD, Christopher Cooper, MD, Angela Arlen, MD, Kristi Ferguson, PhD, Douglas Storm, MD.
University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
Background:
Bowel and bladder dysfunction is a common problem in children. Current questionnaires were validated using small sample populations, and may not easily quantitate patients’ voiding and bowel related symptoms. We developed a new bladder and bowel questionnaire to objectively measure voiding and bowel symptoms and to follow patients’ symptoms over time. We evaluated the performance of this newly devised, objective instrument to quantify or grade the severity of abnormal bowel and bladder behaviors of children.
Methods:
An 18-item instrument, 4-point questionnaire was developed using both a literature review and expert opinions. Total questionnaire score could range from 0-72. Questions were sub-grouped into different symptoms, allowing the practitioner to identify the underlying causes of the patients’ bowel and bladder issues. These symptom groups include: 1) Urinary Holding 2) Incomplete Bladder Emptying 3) Urinary Urgency 4) Nocturnal Enuresis and 5) Constipation. The questionnaire was administered to 1247 consecutive pediatric urology clinic patients. The patients were divided into two groups: 1) Cases and 2) Controls. Cases consisted of patients presenting for evaluation of bowel symptoms, urinary symptoms, daytime incontinence, nighttime incontinence, and/or constipation. Controls consisted of an age-matched group presenting for evaluation of a non-bladder/bowel urologic issue.
Results: Table 1 demonstrates patient demographics and compares symptoms between the two study groups.
Table 1. Comparison of Cases and Controls
| Cases | Controls | p value | ||
| Sex | Female | 355 (57%) | 227 (35%) | <0.01 |
| Male | 268 (43%) | 415 (65%) | ||
| Mean Age (years) | 9.6 (1-19) | 9.0 (2-19) | 0.03 | |
| Mean Number of Symptoms | 2.9 (0-5) | 1.2 (0-5) | <0.01 | |
| Mean Questionnaire Score | 22 (0-58) | 11.7 (0-55) | <0.01 | |
Reliability analysis of the 18-item instrument showed a Cronbach’s alpha reliability coefficient of .80 for the scale. A t-test of the total scores comparing cases and controls on the scale showed a statistically significant result at p < .0001 (mean for cases=21, mean for controls=9). In addition, the Pearson correlation coefficient between scores on the questionnaire and the number of subjective complaints (as identified through chart review) was .81.
Conclusions: This new instrument provides a valid and reliable method for measuring voiding and bowel symptoms. Its results can be used to reliably categorize, describe, screen and follow patients’ dysfunctional bladder and bowel symptoms.
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