Bowel Management Alone Effective for Pediatric Daytime Urinary Incontinence: JAMA
Researchers have found in a new randomized trial that among children with bladder and bowel dysfunction, bowel management alone significantly improved Daytime Urinary Incontinence. Adding Urotherapy at treatment initiation did not provide additional benefit. These findings support bowel management as the preferred first-line approach and suggest it may be essential before considering standard urotherapy. The study was published in JAMA Network Open by Sofie A. and colleagues.
To determine whether the use of combined treatments produces better results compared to bowel dysfunction treatment alone, researchers conducted a parallel randomized control trial involving five pediatric outpatient clinics in Denmark. The trial began on September 1, 2022, and will conclude on July 31, 2025, during which time children between ages 5 and 14 who are naive to any bladder and bowel disorders treatments will undergo observation for 12 weeks.
There were 94 children (median age 6.9 years; interquartile range 6.1-8.2 years; 60.6% male) enrolled in the study, of which 83 completed the entire procedure. In the intervention group, participants underwent 12 weeks of intensive bowel management without other treatments such as disimpaction, maintenance laxatives, timely toileting post-meals, and caregiver training. In the second intervention group, the same intensive bowel management procedure was done but paired with urotherapy, which involved timed voiding, proper toileting positioning, adequate fluid intake, and bladder training.
Key findings:
- The base line daily probability of having a wet day for all randomized children was 0.75 (95% CI, 0.70-0.80) which equated to 5.3 wet days per week (95% CI, 4.9-5.6).
- At 12 weeks post treatment, daily probabilities of wet day occurrence were reduced to 0.54 (95% CI, 0.44-0.65) for bowel monotherapy group and 0.55 (95% CI, 0.45-0.66) for combination therapy group.
- Wet days per week were reduced significantly to 3.8 days (95% CI, 3.0-4.6) for monotherapy group and 3.9 days (95% CI, 3.1-4.6) for combination group.
- Of the total randomized population, 16 children (38.1%; 95% CI, 23.6%-54.4%) in the monotherapy group and 12 children (29.3%; 95% CI, 16.1%-45.5%) in the combination group had experienced a 50% or higher reduction in wet days per week.
- Complete dryness was observed in 6 children (14.3%; 95% CI, 5.4%-28.5%) in the monotherapy group and 4 children (9.8%; 95% CI, 2.7%-23.1%) in the combination group.
- In addition, of the total successful resolution of functional constipation at 12 weeks post treatment, the predicted mean number of wet days per week was reduced.
The study demonstrates that bowel management alone is very efficacious and sufficient as a first-line therapy for bladder/bowel dysfunction among children. Since simultaneous implementation of urotherapy does not add any additional benefits, current medical practice must be adjusted accordingly, with new guidelines being made for a stepwise treatment protocol.
Reference:
Axelgaard S, Kamperis K, Hagstrøm S, et al. Bowel Management and Standard Urotherapy in Pediatric Bladder and Bowel Dysfunction: A Randomized Clinical Trial. JAMA Netw Open. 2026;9(4):e268836. doi:10.1001/jamanetworkopen.2026.8836
