Prevalence of Incontinence and Risk Factors in Children With Cerebral Palsy

Study Overview
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Brief Summary
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This study evaluates (risk)factors influencing (in)continence in children with and without a brain injury.

Detailed Description
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Children with cerebral palsy (CP) (Rosenbaum, 2007) gain bladder and bowel control at older age compared to typical developing children (Ozturk, 2006). The incidence of urinary incontinence during day and night, fecal incontinence and constipation is higher in this population. Incontinence in children is often treated with urotherapy. This is a nonsurgical, nonpharmacological treatment for lower urinary tract dysfunctions. Standard urotherapy is noninterventional and it includes giving information, instructions, advice regarding life-style, fluid intake and bladder diaries. Additionally specific interventions can be used, such as: various forms of pelvic floor training, behavioral modification, biofeedback, electrical stimulation and catheterization (Neveus, 2006). Recent research has proven urotherapy to be successful for the treatment of children with daytime incontinence (Mulders, 2010). Despite the high prevalence of incontinence in children with CP the possible treatment strategies in this population are poorly investigated. Far too often, urinary incontinence in children with CP is considered a normal, unavoidable and even a minor problem. Aim: Analyze (risk) factors influencing (in)continence in children with and without CP. Possible parameters will be registered through questioning, measurement (uroflow combined with pelvic floor EMG and postmictional residue) and retrospective analysis of the patient files. Parameters will be compared between continent and incontinent children with and without CP. This comparison evaluates whether the same therapeutic strategies can be applied in incontinent children with and without CP.

Official Title
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Prevalence of Incontinence and Risk Factors in Children With Cerebral Palsy

Conditions
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Urinary Incontinence

Intervention / Treatment
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* Other: Questionnaire and micturition and drinking diaries
* Procedure: Uroflowmetry, pelvic floor EMG and bladderscan


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Daytime urinary incontinence with or without enuresis and/or fecal incontinence (Groups with incontinence) No urinary or fecal incontinence (Groups without incontinence) Cerebral palsy (Groups with children with CP) Normal development (Groups with children without CP) Exclusion Criteria: Isolated urinary tract infections Isolated enuresis Isolated dysfunctional voiding Isolated fecal incontinence Anatomical abnormalities History of genitourinary or renal surgery Medication for incontinence during the last 3 months Pelvic reeducation during the last 6 months Other neurologic problems influencing continence

Ages Eligible for Study
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Minimum Age: 5 Years
Maximum Age: 12 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| CP- incontinent<br>Children with CP and daytime incontinence. Evaluation consisted of a questionnaire and micturition and drinking diaries, uroflowmetry, pelvic floor EMG and bladderscan. | Other: Questionnaire and micturition and drinking diaries<br>* Questionnaire: ICCS parental questionnaire + extended history taking document, ROME III criteria, demographic information and/or PIN-Q. Diaries: 24-hour voiding chart<br>Procedure: Uroflowmetry, pelvic floor EMG and bladderscan<br>* Voiding variables, pelvic floor activity during micturition and postmictional residue.<br>|
| CP- continent<br>Children with CP without daytime incontinence. Evaluation consisted of a questionnaire and micturition and drinking diaries, uroflowmetry, pelvic floor EMG and bladderscan. | Other: Questionnaire and micturition and drinking diaries<br>* Questionnaire: ICCS parental questionnaire + extended history taking document, ROME III criteria, demographic information and/or PIN-Q. Diaries: 24-hour voiding chart<br>Procedure: Uroflowmetry, pelvic floor EMG and bladderscan<br>* Voiding variables, pelvic floor activity during micturition and postmictional residue.<br>|
| NoDev - incontinent<br>Children with normal development with daytime incontinence. Evaluation consisted of a questionnaire and micturition and drinking diaries, uroflowmetry, pelvic floor EMG and bladderscan. | Other: Questionnaire and micturition and drinking diaries<br>* Questionnaire: ICCS parental questionnaire + extended history taking document, ROME III criteria, demographic information and/or PIN-Q. Diaries: 24-hour voiding chart<br>Procedure: Uroflowmetry, pelvic floor EMG and bladderscan<br>* Voiding variables, pelvic floor activity during micturition and postmictional residue.<br>|
| NoDev - continent<br>Children with normal development without daytime incontinence. Evaluation consisted of a questionnaire and micturition and drinking diaries, uroflowmetry, pelvic floor EMG and bladderscan. | Other: Questionnaire and micturition and drinking diaries<br>* Questionnaire: ICCS parental questionnaire + extended history taking document, ROME III criteria, demographic information and/or PIN-Q. Diaries: 24-hour voiding chart<br>Procedure: Uroflowmetry, pelvic floor EMG and bladderscan<br>* Voiding variables, pelvic floor activity during micturition and postmictional residue.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Risk factors | Identification of predictive factors for incontinence in children with and without CP. | Cross-sectional | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Cerebral Palsy, Risk factors, Child, urinary incontinence