Voiding dysfunction related to adverse childhood experiences and neuropsychiatric disorders

ObjectiveResearch has demonstrated the effect of adverse childhood experiences (ACEs) on later physiologic function and illness development. In the urologic literature, the relationship between bladder dysfunction and neuropsychiatric disorders is well documented. Observations in pediatric urology clinical practice suggest that a blend of these two areas of research can inform care of patients with voiding dysfunction.MethodsRetrospective review of 216 patients seen in a single pediatric urology clinic by a single provider over a 24-month period. A descriptive, correlational study design was used to assess the extent to which ACEs and neuropsychiatric disorders affected resolution of symptoms when patients were treated with a bowel and bladder retraining program. Patients were selected using diagnostic codes related to voiding dysfunction and a retrospective chart review was conducted.ResultsA majority of patients who were seen for voiding dysfunction (60%) had at least one psychosocial factor. There is a greater prevalence of ACEs (51%) than neuropsychiatric disorders (25%). Children with either ACEs or neuropsychiatric disorders dropped out of treatment at a higher rate than those with neither. When factors were looked at separately, neuropsychiatric disorders were more likely to impede treatment progress than ACEs.ConclusionsACEs and neuropsychiatric disorders affect patients' ability to make progress with bowel and bladder retraining and to stay in treatment. Efforts specifically aimed at maintaining therapeutic relationships with patients who have ACEs are needed to fully treat this group, which typically has a high drop-out rate but high rate of resolution if they are able to stay involved in treatment.