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Impact of ADHD medication status on Bladder Bowel Dysfunction Treatment
Amy Huang, MD1, Andrea Rossman, MD1, Christopher Cooper, MD1, Logan Harris, BS1, Angelena Edwards, MD2.
1University Of Iowa, Iowa City, IA, USA, 2University of Louisville, Louisville, KY, USA.
BACKGROUND: The Iowa Pediatric Bladder Bowel Dysfunction Questionnaire is a validated 18-item survey that yields total and subcategories scores (nocturnal enuresis, lower urinary tract symptoms, bowel symptoms, and quality of life (QoL)). Our previous study found children with Bladder Bowel Dysfunction (BBD) and attention deficit hyperactivity disorder (ADHD) not taking ADHD medication had significantly higher total BBD questionnaire scores at their initial visit compared to ADHD peers taking ADHD medication. The objective of this study is to further compare BBD questionnaire subcategories stratified by their treatment regimen.
METHODS: The study population comprised of patients 5—18 years of age seen between 1/1/2015 and 12/30/2022 who met the inclusion criteria of a BBD diagnosis, a formal psychological diagnosis of ADHD, and had at least 2 visits. BBD treatments included behavioral modifications, bowel regimens, and anticholinergic medications.
RESULTS: In those who received behavioral modification only, individuals not taking ADHD medication had significantly higher initial visit scores for their bowel symptoms (p=0.001) and QOL questions (p=0.002) compared to their peers taking ADHD medication. At the first follow-up visit, those not taking ADHD medication had persistently significantly higher bowel symptom scores (p=0.001) along with higher bladder symptoms (p=0.034). At the final visit, those taking not ADHD medication had significantly higher scores for the bowel (p=0.0007) and QOL questions(p=0.018) with no statistical difference in in final bladder-based question scores. In those who received behavioral modification and a bowel regimen, individuals not taking ADHD medication had significantly lower scores in their bowel symptoms at first follow-up (p=0.0009) and bladder (p=0.002) and bowel symptoms at final visit (p=0.0000001). In individuals receiving behavioral medication, bowel regimen and anticholinergic medical therapy, patients taking ADHD medication had significantly higher scores for the bladder questions at the initial visit.
However, at the first follow-up visit, patients not taking ADHD medication had significantly higher scores for the bladder (p=0.0008) and QoL (0.0001) questions, but only the QoL (0.0001) questions at final visit.
CONCLUSIONS: In individual with ADHD and BBD those not taking medication for their ADHD treated with behavioral therapy have more significant bowel symptoms at presentation and persist throughout treatment compared to those on ADHD medication.
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