Factors influencing incontinence in children with cerebral palsy
Functional impairment, intellectual disability and fluid intake are important risk factors for urinary incontinence in children with cerebral palsy (CP), a study has found.
The cross-sectional case-control study included paediatric CP patients with urinary incontinence (n=34) or without the urologic condition (n=45). Factors were clustered under three categories: demographic and general medical data, CP classification, and bladder and bowel dysfunction. Assessments were performed using uroflowmetry/electromyography, a nonvalidated questionnaire and bladder diaries.
The resulting data demonstrated that UI was associated with intellectual disability (odds ratio [OR], 7.69), swallowing problems (OR, 15.11), use of external aids (OR, 27.50) and use of laxatives (OR, 13.31). A positive relationship with the urologic condition was also seen for dyskinesia (OR, 5.67) or combined spasticity and dystonia (OR, 4.78), bilateral involvement (OR, 4.25), gross motor function classification system level IV (OR, 10.63) and V (OR, 34.00), and severe impairment in manual (OR, 24.27) or communication skills (OR, 14.38).
On the other hand, UI was negatively associated with lower maximum voided volume (OR, 0.97) and oral fluid intake (OR, 0.96). Pathological uroflow curves had no influence on and were not significantly associated with incontinence.
A final associative logistic model including all clusters defined functional impairment, intellectual disability and oral fluid intake as predictive factors for UI.
Representing a group of chronic, nonprogressive motor disorders, CP is characterized by impaired voluntary movement caused by prenatal developmental abnormalities or perinatal or postnatal central nervous system damage. Affected patients, either adults or children, commonly present with urinary incontinence, faecal incontinence and constipation. The development of bladder and bowel control is said to be influenced by neurological impairment in CP. [Croat Med J 2006;47:264–270]