Parents who have children that suffer from ADHD as well as doctors and therapists who treat these families are well aware that there is a higher rate of difficulty with regard to bladder control for these children. This most times is at night but may also be a problem throughout the day as well. In addition to an obvious sign of delayed development, this also has considerable social stigma attached to it. A recent study in the Journal of Urology confirms and brings into objective evidence what those of us in the field already know. Yes, children who have ADHD are far more likely to have issues with bladder urgency and eneuresis ( bed wetting.) In fact, the higher the child scored on the Connors Parent Rating Scale a psychometric tests for ADHD, the more likely he or she was to have urgency.
In the functional neurology model, this association between ADHD and bladder control makes perfect sense. An under developed cortex or higher brain is going to give one less ability to resist a socially inappropriate urges as well as a lower reflexes such as relating to your bladder. Let’s combine the two situations to make an example. When your bladder fills, you will have the urge two empty your bladder. This is what you do as an infant. It is a reflex. As your higher brain develops you become aware that it is socially inappropriate to empty your bladder whenever it feels full. It is your higher brain which is able to inhibit the bladder reflex to empty your bladder. Thus, if you’re higher brain is not developed sufficiently you will not be able to inhibit the lower bladder reflex and you will have urgency and daytime as well as night time accidents. Now, let’s look a situation in which the child is able to control his bladder during the day but has issues with bed wetting at night. In this situation, your cortex or higher brain is less active at night when you are sleeping. Therefore, you have less ability to inhibit the lower bladder reflex and thus your bladder empties. In the second case, the child’s cortex is sufficiently developed to inhibit the bladder reflex during the day however with decreased cortical activity at night, his ability to inhibit the bladder reflex falls below threshold and he loses his ability to inhibit.
The trick of course is to find the appropriate exercise to stimulate the under functioning area of the brain (the area of dysfunction must be localized) in order to accelerate its development and address both the issue with ADHD and bladder control. This of course is the job of the functional neurology practitioner.
J Urol. 2011 Feb;185(2):663-8. Epub 2010 Dec 18.
Lower urinary tract conditions in children with attention deficit hyperactivity disorder: correlation of symptoms based on validated scoring systems.
Department of Urology, Ankara University School of Medicine, Ankara, Turkey.
PURPOSE: We investigated whether certain voiding problems have a higher incidence in patients with attention deficit disorder with hyperactivity compared to age matched controls.
MATERIALS AND METHODS: We used the Conners Parent Rating Scale-revised for attention deficit disorder with hyperactivity and lower urinary tract symptom score to evaluate voiding problems. A total of 62 children with attention deficit disorder and 124 healthy controls were enrolled. We evaluated uroflowmetry patterns in both groups. Residual urine volumes and Bristol stool scale were noted. We examined the correlation between total Conners Parent Rating Scale-revised and lower urinary tract symptom score in patients with attention deficit disorder. Additionally we analyzed each index of the Conners Parent Rating Scale-revised separately in terms of correlation with symptom subgroups for lower urinary tract symptom scores.
RESULTS: Mean ± SD total lower urinary tract symptom score was 11.1 ± 2.9 in patients with attention deficit disorder with hyperactivity and 3.2 ± 1.3 in controls, a difference that was statistically significantly (p <0.001). With the exception of constipation, mean scores of all lower urinary tract symptom subindices were significantly higher in patients with attention deficit disorder compared to controls. Symptoms evaluated in lower urinary tract symptom score were mostly correlated with attention deficit disorder index of the Conners Parent Rating Scale-revised. If a child with attention deficit disorder has a high index in the Conners Parent Rating Scale-revised, he or she is more likely to have urgency. Also, if a child with attention deficit disorder has a high hyperactivity subscale score, he or she is more likely to have enuresis.
CONCLUSIONS: Voiding problems are more common in children with attention deficit disorder with hyperactivity than in age matched controls. Urgency and enuresis are the outstanding problems in children with attention deficit disorder. Simultaneous use of the Conners Parent Rating Scale-revised and lower urinary tract symptom score questionnaire should be encouraged in patients with attention deficit disorder to allow a structured and quantitative evaluation of these overlapping problems.
Copyright Â© 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
PMID: 21172714 [PubMed - in process]