Management of constipation in preventing urinary tract infections in children: a concise review

Year 2019, Volume: 5 Issue: 2, 236 - 243, 04.03.2019

Marco Zaffanello , Claudia Banzato Giorgio Piacentini

https://doi.org/10.18621/eurj.412280

Cited By: 4

Abstract

Objectives: Constipation
is a common problem in children. Chronic
functional constipation (CFC) has been a claimed conditions that may increase
the risk for urinary tract infections (UTIs). Dysfunctional voiding (DV) and lower urinary tract
dysfunctions (LUTD) with chronic constipation are referred to dysfunctional
elimination syndromes (DES). The
aim of the present review is to look at the management of constipation in children
with CFC or DES in reducing the risk of recurrent UTIs.

Methods: We
performed a literature search on electronic databases (Pubmed and Scopus) for
relevant clinical trials investigating the results of one or more treatments
for children’s constipation in the term of UTIs recurrence.

Results: The search
strategy identified 20 valuable clinical trials. The studies are not
homogenous but showed an improvement in UTIs occurrences in children managed
for bowel dysfunction.

Conclusion: In
conclusion, children referred to a pediatric nephrologist for UTIs should
include an inquiry bowel habits and those with a positive assessment for bowel
dysfunction needs the collaboration with a pediatric gastroenterologist with a
multidisciplinary approach. 

Keywords

Children, constipation, dysfunctional elimination syndromes, dysfunctional voiding, urinary tract infection

References

• [1] White B. Diagnosis and treatment of urinary tract infections in children Am Fam Physician 2011;83:409-15.
• [2] Vachvanichsanong P. Urinary tract infection: one lingering effect of childhood kidney diseases--review of the literature. J Nephrol 2007;20:21-8.
• [3] Saadeh SA, Mattoo TK. Managing urinary tract infections. Pediatr Nephrol 2011;26:1967-76.
• [4] Keren R, Shaikh N, Pohl H, Gravens-Mueller L, Ivanova A, Zaoutis L, et al. Risk factors for recurrent urinary tract infection and renal scarring. Pediatrics 2015;136:e13-21.
• [5] Zaffanello M, Tardivo S, Cataldi L, Fanos V, Biban P, Malerba G. Genetic susceptibility to renal scar formation after urinary tract infection: a systematic review and meta-analysis of candidate gene polymorphisms. Pediatr Nephrol 2011;26:1017-29.
• [6] Shaikh N, Hoberman A, Keren R, Gotman N, Docimo SG, Mathews R, et al. Recurrent urinary tract infections in children with bladder and bowel dysfunction. Pediatrics 2016;137:e20152982.
• [7] Dehghani SM, Basiratnia M, Matin M, Hamidpour L, Haghighat M, Imanieh MH. Urinary tract infection and enuresis in children with chronic functional constipation. Iran J Kidney Dis 2013;7:363-6.
• [8] van den Berg MM, Benninga MA, Di Lorenzo C. Epidemiology of childhood constipation: a systematic review. Am J Gastroenterol 2006;101:2401-9.
• [9] Benninga M, Candy DC, Catto-Smith AG, Clayden G, Loening-Baucke V, Di Lorenzo C et al. The Paris Consensus on Childhood Constipation Terminology (PACCT) Group. J Pediatr Gastroenterol Nutr 2005;40:273-5.
• [10] Constipation Guideline Committee of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. Evaluation and treatment of constipation in infants and children: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr 2006;43:e1-13.
• [11] Tabbers MM, DiLorenzo C, Berger MY, Faure C, Langendam MW, Nurko S, et al.; European Society for Pediatric Gastroenterology, Hepatology, and Nutrition; North American Society for Pediatric Gastroenterology. Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr 2014;58:258-74.
• [12] Xin HW, Fang XC, Zhu LM, Xu T, Fei GJ, Wang ZF, et al. Diagnosis of functional constipation: agreement between Rome III and Rome II criteria and evaluation for the practicality. J Dig Dis 2014;15:314-20.
• [13] Halachmi S, Farhat WA. Interactions of constipation, dysfunctional elimination syndrome, and vesicoureteral reflux. Adv Urol 2008:828275.
• [14] Austin PF, Bauer SB, Bower W, Chase J, Franco I, Hoebeke P, et al. The standardization of terminology of lower urinary tract function in children and adolescents: Update report from the standardization committee of the International Children's Continence Society. Neurourol Urodyn 2016;35:471-81.
• [15] Koff SA, Wagner TT, Jayanthi VR. The relationship among dysfunctional elimination syndromes, primary vesicoureteral reflux and urinary tract infections in children. J Urol 1998;160(3 Pt 2):1019-22.
• [16] Sinha S. Dysfunctional voiding: A review of the terminology, presentation, evaluation and management in children and adults. Indian J Urol 2011;27:437-47.
• [17] Kasirga E, Akil I, Yilmaz O, Polat M, Gozmen S, Egemen A. Evaluation of voiding dysfunctions in children with chronic functional constipation. Turk J Pediatr 2006;48:340-3.
• [18] da Fonseca EM, Santana PG, Gomes FA, Bastos MD. Dysfunction elimination syndrome: is age at toilet training a determinant? J Pediatr Urol 2011;7:332-5.
• [19] Romanczuk W, Korczawski R. Chronic constipation: a cause of recurrent urinary tract infections. Turk J Pediatr 1993;35:181-8.
• [20] Giramonti KM, Kogan BA, Agboola OO, Ribons L, Dangman B. The association of constipation with childhood urinary tract infections. J Pediatr Urol 2005;1:273-8.
• [21] Wan J, Kaplinsky R, Greenfield S. Toilet habits of children evaluated for urinary tract infection. J Urol 1995;154(2 Pt 2):797-9.
• [22] Blethyn AJ, Jenkins HR, Roberts R, Verrier Jones K. Radiological evidence of constipation in urinary tract infection. Arch Dis Child 1995;73:534-5.
• [23] Chrzan R, Klijn AJ, Vijverberg MA, Sikkel F, de Jong TP. Colonic washout enemas for persistent constipation in children with recurrent urinary tract infections based on dysfunctional voiding. Urology 2008;71:607-10.
• [24] Ojetti V, Bruno G, Paolucci V, Triarico S, D'aversa F, Ausili E, et al. The prevalence of small intestinal bacterial overgrowth and methane production in patients with myelomeningocele and constipation. Spinal Cord 2014;52:61-4.
• [25] Kibar Y, Ors O, Demir E, Kalman S, Sakallioglu O, Dayanc M. Results of biofeedback treatment on reflux resolution rates in children with dysfunctional voiding and vesicoureteral reflux. Urology 2007;70:563-6; discussion 6-7.
• [26] Vesna Z, Milica L, Marina V, Andjelka S, Lidija D. Correlation between uroflowmetry parameters and treatment outcome in children with dysfunctional voiding. J Pediatr Urol 2010;6:396-402.
• [27] Vesna ZD, Milica L, Stankovic I, Marina V, Andjelka S. The evaluation of combined standard urotherapy, abdominal and pelvic floor retraining in children with dysfunctional voiding. J Pediatr Urol 2011;7:336-41.
• [28] Zivkovic V, Lazovic M, Vlajkovic M, Slavkovic A, Dimitrijevic L, Stankovic I, et al. Diaphragmatic breathing exercises and pelvic floor retraining in children with dysfunctional voiding. Eur J Phys Rehabil Med 2012;48:413-21.
• [29] Kajbafzadeh AM, Sharifi-Rad L, Ghahestani SM, Ahmadi H, Kajbafzadeh M, Mahboubi AH. Animated biofeedback: an ideal treatment for children with dysfunctional elimination syndrome. J Urol 2011;186:2379-84.
• [30] Humphreys MR, Vandersteen DR, Slezak JM, Hollatz P, Smith CA, Smith JE, et al. Preliminary results of sacral neuromodulation in 23 children. J Urol 2006;176:2227-31.
• [31] De Paepe H, Renson C, Van Laecke E, Raes A, Vande Walle J, Hoebeke P. Pelvic-floor therapy and toilet training in young children with dysfunctional voiding and obstipation. BJU Int 2000;85:889-93.
• [32] Vasconcelos M, Lima E, Caiafa L, Noronha A, Cangussu R, Gomes S, et al. Voiding dysfunction in children. Pelvic-floor exercises or biofeedback therapy: a randomized study. Pediatr Nephrol 2006;21:1858-64.
• [33] Yagci S, Kibar Y, Akay O, Kilic S, Erdemir F, Gok F, et al. The effect of biofeedback treatment on voiding and urodynamic parameters in children with voiding dysfunction. J Urol 2005;174:1994-7; discussion 7-8.
• [34] McKenna PH, Herndon CD, Connery S, Ferrer FA. Pelvic floor muscle retraining for pediatric voiding dysfunction using interactive computer games. J Urol 1999;162(3 Pt 2):1056-62; discussion 62-3.
• [35] Barroso U Jr, Lordelo P, Lopes AA, Andrade J, Macedo A Jr, Ortiz V. Nonpharmacological treatment of lower urinary tract dysfunction using biofeedback and transcutaneous electrical stimulation: a pilot study. BJU Int 2006;98:166-71.
• [36] Petronijevic V, Lazovic M, Vlajkovic M, Slavkovic A, Golubovic E, Miljkovic P. Botulinum toxin type A in combination with standard urotherapy for children with dysfunctional voiding. J Urol 2007;178:2599-602; discussion 602-3.
• [37] O'Regan S, Yazbeck S, Schick E. Constipation, bladder instability, urinary tract infection syndrome. Clin Nephrol 1985;23:152-4.
• [38] Loening-Baucke V. Urinary incontinence and urinary tract infection and their resolution with treatment of chronic constipation of childhood. Pediatrics 1997;100(2 Pt 1):228-32.
• [39] Loening-Baucke V. Factors determining outcome in children with chronic constipation and faecal soiling. Gut 1989;30:999-1006.
• [40] Tugtepe H, Thomas DT, Ergun R, Abdullayev T, Kastarli C, Kaynak A, et al. Comparison of biofeedback therapy in children with treatment-refractory dysfunctional voiding and overactive bladder. Urology 2015;85:900-4.
• [41] Khen-Dunlop N, Van Egroo A, Bouteiller C, Biserte J, Besson R. Biofeedback therapy in the treatment of bladder overactivity, vesico-ureteral reflux and urinary tract infection. J Pediatr Urol 2006;2:424-9.
• [42] Amira PA, Dusan P, Gordana ML, Sandra T, Ivanisevic I. Bladder control training in girls with lower urinary tract dysfunction. Int Braz J Urol 2013;39:118-26.
• [43] Sarvari G, Sharbaf FG, Partovi S, Elmi S, Akhavan H, Bakhtiari E. The relationship between chronic constipation and urinary tract infection in children: A case-control clinical study. Int J Pediatr 2017;5:5715-21.
• [44] Montini G, Tullus K, Hewitt I. Febrile urinary tract infections in children. N Engl J Med 2011;365:239-50.
• [45] Morello W, La Scola C, Alberici I, Montini G. Acute pyelonephritis in children. Pediatr Nephrol 2016;31:1253-65.
• [46] Roberts KB. Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics 2011;128:595-610.
• [47] Ammenti A, Cataldi L, Chimenz R, Fanos V, La Manna A, Marra G, et al. Febrile urinary tract infections in young children: recommendations for the diagnosis, treatment and follow-up. Acta Paediatr 2012;101:451-7.
• [48] Peters CA, Skoog SJ, Arant BS Jr, Copp HL, Elder JS, Hudson RG, et al. Summary of the AUA Guideline on Management of Primary Vesicoureteral Reflux in Children. J Urol 2010;184:1134-44.
• [49] Tekgül S, Riedmiller H, Hoebeke P, Kočvara R, Nijman RJ, Radmayr C, et al. EAU guidelines on vesicoureteral reflux in children. Eur Urol 2012;62:534-42.
• [50] Desantis DJ, Leonard MP, Preston MA, Barrowman NJ, Guerra LA. Effectiveness of biofeedback for dysfunctional elimination syndrome in pediatrics: a systematic review. J Pediatr Urol 2011;7:342-8.
• [51] Reck-Burneo CA, Vilanova-Sanchez A, Gasior AC, Dingemans AJM, Lane VA, Dyckes R, et al. A structured bowel management program for patients with severe functional constipation can help decrease emergency department visits, hospital admissions, and healthcare costs. J Pediatr Surg 2018;53:1737-41.