Bladder control problems more common in ADHD

NEW YORK (Reuters Health) - Children with attention-deficit hyperactivity disorder (ADHD) may be more likely than their peers to have problems with bedwetting and other bladder control symptoms, a new study finds.

Turkish researchers found that among 62 children with ADHD and 124 without the disorder, kids with ADHD scored considerably higher on a questionnaire on “voiding” symptoms -- problems emptying the bladder.

In particular, they tended to have more problems with bedwetting and habitually feeling an urgent need to go to the bathroom.

Some past research has suggested that up to 30 percent of children with attention deficit disorders have had problems with wetting themselves, either during the day or while sleeping -- what doctors call enuresis.

The new findings suggest that “the incidence of all voiding problems, not only enuresis, increases in children with ADHD,” Dr. Ozgu Aydogdu, one of the researchers on the study, told Reuters Health in an e-mail.

It’s not fully clear why that is. But it could have to do with the stimulant medications used to treat ADHD, or with the disorder itself, according to Aydogdu, of Ankara University School of Medicine in Turkey.

A pediatric urologist not involved in the study said that it “helps shed a little light” on the association between ADHD and urinary problems.

But the small size limits the conclusions that can be drawn, said Dr. Lane S. Palmer, chief of pediatric urology at Cohen Children’s Medical Center in New Hyde Park, New York.

“I think people have known that there is this association, but it has not been well-catalogued,” Palmer told Reuters Health.

He said that large studies are still needed both to pin down the incidence of bladder-control problems in children with ADHD, and to understand the underlying reasons. Medication side effects could be one factor, Palmer noted, but research is needed to confirm that.

The current findings, published in the Journal of Urology, are based on questionnaires and symptom diaries given to the parents of 62 children with ADHD and 124 without the disorder who served as a “control” group.

On average, children with ADHD scored an 11 on a questionnaire gauging urinary tract symptoms -- including bedwetting and habitually feeling an urgent need to urinate or to “hold” it in. In general, a score of nine or higher suggests bladder problems, according to the researchers.

In contrast, the average score in the ADHD-free group was a three.

When the researchers looked at the children’s symptom diaries, 22 percent of the ADHD group had problems like bedwetting or urinary incontinence over three days. That compared with 5 percent of the control group.

Rates of ADHD vary widely by state, but up to 9.5 percent of U.S. children aged 4 to 17 - a total of 5.4 million kids in 2007 -- have been diagnosed with ADHD, according to the Centers for Disease Control and Prevention. Annual costs associated with the condition range from $12,000 to 17,000 per child.

For parents of kids diagnosed with ADHD, awareness is the bottom line, according to Palmer.

“Parents should be aware that some of these children will have voiding issues,” Palmer said.

He added that some parents might think that voiding problems are “just a part” of ADHD. “But they should be aware that it can be addressed,” he said.

According to Palmer, treatment usually means various types of behavior changes -- like limiting liquids in the evening and having kids wear a programmable watch that reminds them to take bathroom breaks at regular intervals during the day.

It can be more difficult for kids with ADHD to make such changes compared with other children. So it’s important to individualize children’s therapy, Palmer said, which may mean setting smaller goals along the way for kids with ADHD.

“With enough baby steps,” Palmer said, “you’ll get to the end.”

SOURCE: Journal of Urology, online December 21, 2010.