Urinary and fecal incontinence affects quality of life in children and adolescents with spina bifida
Konrad M. Szymanski, MD MPH, Mark P. Cain, MD, Benjamin Whittam, MD MS, Martin Kaefer, MD, Richard C. Rink, MD, Rosalia Misseri, MD.
Riley Hospital for Children, Indianapolis, IN, USA.
BACKGROUND: Despite devoting many resources to the management of urinary incontinence (UI) and fecal incontinence (FI), it remains unclear whether UI and FI are associated with a lower health-related quality of life (HRQOL) in children with spina bifida (SB). We sought to determine the impact of UI and FI on HRQOL in children and adolescents with SB. METHODS: A national sample of children (8-17 years old) with SB living in the United States was surveyed online and in SB clinics (2013-2015). We evaluated incontinence over the past 4 weeks using a UI dry interval (<4h, >=4h), FI clean intervals (<1 week, >=1 week) and self-reported amount of UI and FI (for each: a lot, medium, a little, none). HRQOL was assessed with QUALAS, a validated SB-specific instrument. Linear regression was used for analysis (all outcomes: 0-100). RESULTS: Mean age of 286 participants was 12.5 years (51.8% male). Overall, 73.1% had UI, 52.8% had FI, and 43.7% had both. Adjusting for concurrent UI and FI, any UI was associated with lower HRQOL in children 10-17 years (p<=0.03), but not for 8-9 year olds (p=0.98). Kids of all ages reported lower HRQOL with any FI (p>=0.0003). On multivariate analysis, neither a dry or clean interval was associated with lower HRQOL for any age group (p>=0.22 and p>=0.16, respectively). Higher quantities of UI were associated with ever lower HRQOL: medium and a lot for 10-13 year olds (p<=0.02), and small, medium and a lot for 14-17 year olds (p<=0.002). Any quantity of FI was associated with lower HRQOL in all ages. Findings did not change significantly on exploratory analysis correcting for demographic and clinical variables. CONCLUSIONS: UI is negatively associated with HRQOL in children with SB in an age-dependent fashion: starting in 10 year olds and increasing at 14 years. FI correlates with lower HRQOL regardless of age. Similar to findings in adults with SB, HRQOL is lower with increasing amounts of UI rather than a dry interval. FI has a more uniform impact on HRQOL, regardless of frequency or amount.
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