PC2160: Association of Neuropsychiatric Disease with Bowel and Bladder Dysfunction

Background: Currently, no large-scale studies exist regarding voiding dysfunction and elimination dysfunction disorders with neuropsychiatric illnesses in a military pediatric cohort. This study offers critical information to better understand and elucidate the health and wellbeing of military-connected children, and may be generalized to civilian cohorts to extend scientific understanding of the hypothesized relationship between neuropsychiatric illness and elimination/voiding disorders.

Methods: A retrospective cohort study was conducted using data between 2007-2019 from the Military Health System database. Specifically, pediatric patients 4 to 12 years old with at least two outpatient encounters and no more than 120 days between visits from Naval Hospital Camp Pendleton or Naval Medical Center San Diego were included in the current analyses. Descriptive statistics were used to describe the population and to evaluate the prevalence of comorbid voiding/elimination dysfunction disorders and mental health conditions.

Results: In total, 16,877 patients (51% male, 49% female) were identified for inclusion. Prevalence of attention deficit disorder (ADD), attention deficit hyperactivity disorder (ADHD), anxiety, autism, depression, and oppositional defiant disorder (ODD) during the study period were 2.4%, 9.2%, 1.6%, 1.5%, 0.8%, and 0.8%, respectively. Chi-square tests were used to evaluate associations between elimination disorders (i.e., encopresis, constipation), voiding disorders (i.e., enuresis, urinary frequency, urinary incontinence, dysuria, and urinary urgency), urinary tract infections, and mental health conditions (see Table). Elimination dysfunction disorders were significantly more common in patients with ADHD, anxiety, and autism. Voiding dysfunction disorders were significantly more prevalent in patients with ADHD, anxiety, and depression. UTIs were significantly associated with ADD diagnoses. Patients with ODD had no significant associations with the urologic diagnoses included in this study.

Conclusion: Several neuropsychiatric disorders appear associated with bowel and/or bladder dysfunction. This study will inform clinical practice, addressing overall physical and mental health among children in military families. This work will be expanded to include DoD-wide pediatric cohort data, and will include additional ICD-9/ICD-10 codes on military and general life experiences (e.g., parent deployments and separations, adverse childhood experiences) additional mental health concerns (e.g., PTSD), and other urologic diagnoses to explore associations across diagnostic categories of interest.