Bladder control problems and ADHD

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, those with ADHD scored considerably higher on a questionnaire on voiding symptoms.

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

Affects 30% of children with ADHD

Some past research has suggested that up to 30% of children with attention deficit disorders have had problems with enuresis, either during the day or while sleeping.

The new findings suggest that "the incidence of all voiding problems, not only enuresis, increases in children with ADHD," said Dr Ozgu Aydogdu.

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.

Study 'sheds a little light'

A paediatric 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 paediatric urology at Cohen Children's Medical Centre in New York in the US.

"I think people have known that there is this association, but it has not been well-catalogued," Palmer said.

Bigger study needed

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.

On average, children with ADHD scored an 11 on a questionnaire gauging urinary tract symptoms - including bed wetting 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% of the ADHD group had problems like bed wetting or urinary incontinence over three days. That compared with 5% of the control group.

Rates of ADHD vary widely by state, but up to 9.5% of US children aged four to 17 - a total of 5.4 million kids in 2007 - have been diagnosed with ADHD, according to the Centres for Disease Control and Prevention. Annual costs associated with the condition range from $12,000 to 17,000 (R84,000 to R120,000) per child.

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

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 behaviour 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 individualise 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." - (Amy Norton/Reuters Health, January 2011)

Read more:
ADHD Expert
What causes ADHD?
How to treat bedwetting

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