It is recognized that there is a strong association between bladder and bowel dysfunction. We determined the association of constipation and/or encopresis with specific lower urinary tract conditions.

Materials and Methods:

We reviewed our database of children with lower urinary tract dysfunction and divided cases into 3 categories of bowel dysfunction (constipation, encopresis and constipation plus encopresis) and 4 lower urinary tract conditions (dysfunctional voiding, idiopathic detrusor overactivity disorder, detrusor underutilization disorder and primary bladder neck dysfunction). Associations between bowel dysfunction types and each lower urinary tract condition were determined.


Of 163 males and 205 females with a mean age of 8.5 years constipation was the most common bowel dysfunction (27%). Although encopresis is generally thought to reflect underlying constipation, only half of children with encopresis in this series had constipation. Dysfunctional voiding was associated with the highest incidence of bowel dysfunction. All but 1 patient with encopresis had associated urgency and detrusor overactivity, and the encopresis resolved in 75% of patients after initiation of anticholinergic therapy. Constipation was significantly more common in girls (27%) than in boys (11%, p <0.01), while encopresis was more common in boys (9%) than in girls (3%, p = 0.02), likely reflecting the higher incidence of dysfunctional voiding in girls and idiopathic detrusor overactivity disorder in boys.


Active bowel dysfunction was seen in half of the children with a lower urinary tract condition. Constipation was more common in patients with dysfunctional voiding, while encopresis was significantly increased in those with idiopathic detrusor overactivity disorder and in those with dysfunctional voiding, severe urgency and detrusor overactivity. Anticholinergics, despite their constipating effect, given for treatment of detrusor overactivity resolved encopresis in most children with this bowel dysfunction.


  • 1 : The relationship among dysfunctional elimination syndromes, primary vesicoureteral reflux and urinary tract infections in children. J Urol1998; 160: 1019. LinkGoogle Scholar
  • 2 : Dysfunctional voiding disorders and nocturnal enuresis. In: Clinical Pediatric Urology. Edited by . London: Martin Dunitz Ltd2002: 345. Google Scholar
  • 3 : Constipation associated with vesicoureteral reflux. Urology1986; 28: 394. Google Scholar
  • 4 : Constipation in infants and children: evaluation and treatment. J Pediatr Gastroenterol Nutr1999; 29: 612. Google Scholar
  • 5 : Functional constipation in children. J Urol2004; 171: 2641. LinkGoogle Scholar
  • 6 : The standardization of terminology of lower urinary tract function in children and adolescents: report from the Standardisation Committee of the International Children's Continence Society. J Urol2006; 176: 314. LinkGoogle Scholar
  • 7 : Encopresis and soiling. Pediatr Clin North Am1996; 43: 279. Google Scholar
  • 8 : Review of the treatment literature for encopresis, functional constipation, and stool-toileting refusal. Ann Behav Med2000; 22: 260. Google Scholar
  • 9 : Childhood functional gastrointestinal disorders: child/adolescent. Gastroenterology2006; 130: 1527. Google Scholar
  • 10 : Simplifying the diagnosis of 4 common voiding conditions using uroflow/electromyography, electromyography lag time and voiding history. J Urol2011; 186: 1721. LinkGoogle Scholar
  • 11 : Nonneurogenic voiding disorders in children and adolescents: clinical and videourodynamic findings in 4 specific conditions. J Urol2010; 184: 2123. LinkGoogle Scholar
  • 12 : Primary bladder neck dysfunction in children and adolescents I: pelvic floor electromyography lag time—a new noninvasive method to screen for and monitor therapeutic response. J Urol2005; 173: 207. LinkGoogle Scholar
  • 13 : Rethinking current concepts and terminology in pediatric bladder and bowel dysfunction. J Pediatr Urol2012; 8: 454. Google Scholar
  • 14 : Painful defecation and fecal soiling in children. Pediatrics1992; 89: 1007. Google Scholar
  • 15 : Children with encopresis: a descriptive analysis. Pediatrics1975; 56: 412. Google Scholar
  • 16 : Chronic and occult stool retention: a clinical tool for its evaluation in school-aged children. Clin Pediatr (Phila)1979; 18: 674. Google Scholar
  • 17 : Evaluation of a method of assessing fecal loading on plain abdominal radiographs in children. Pediatr Radiol1999; 29: 255. Google Scholar
  • 18 : Radiological assessment of constipation. Arch Dis Child1995; 73: 532. Google Scholar
  • 19 : Psychosocial co-morbidity affects treatment outcome in children with fecal incontinence. Eur J Pediatr2008; 167: 985. Google Scholar
  • 20 : Value of abdominal radiography, colonic transit time, and rectal ultrasound scanning in the diagnosis of idiopathic constipation in children: a systematic review. J Pediatr2012; 161: 44. Google Scholar
  • 21 : How accurate is the recall of bowel habits in children with defecation disorders?. Eur J Pediatr1997; 156: 178. Google Scholar
  • 22 : Short pelvic floor electromyographic lag time: a novel noninvasive approach to document detrusor overactivity in children with lower urinary tract symptoms. J Urol2013; 189: 2282. AbstractGoogle Scholar
  • 23 : Transabdominal ultrasound of rectum as a diagnostic tool in childhood constipation. J Urol2008; 179: 1997. LinkGoogle Scholar
  • 24 : Stool form scale as a useful guide to intestinal transit time. Scand J Gastroenterol1997; 32: 920. Google Scholar

Division of Pediatric Urology, Morgan Stanley Children's Hospital of New York-Presbyterian, Department of Urology, Columbia University, College of Physicians and Surgeons, New York, New York