Background:
Bladder and bowel dysfunction (BBD) is characterized by lower urinary tract symptoms
accompanied by bowel complaints. BBD is a common condition in childhood. The present
treatment strategy for BBD is a step-wise approach starting with management of bowel symptoms
before initiation of standard urotherapy and further medical treatment of LUTS symptoms. This
is, however, based on clinical experience and few retrospective, non-randomized studies and
high-level evidence of the succession of the elements in treatment of BBD children is
missing.
Our microbiome, and its role in health and disease, has gained increased focus during the
past years. Studies suggest the urine and gut microbiome to be critical for maintenance of a
well-functioning bladder- and bowel system. The microbiome in children is only sparsely
investigated and its role in BBD is to the investigator's knowledge still unexplored.
Study 1:
Aim: To investigate if combination therapy is more effective in treating urinary incontinence
in BBD children.
Materials and methods: A prospective randomized multicentre study on children with BBD
(n=100) between 5-14 years and 9 months old. They are randomized to: 1) Medical treatment of
bowel symptoms (n=50) or 2) Medical treatment of bowel symptoms combined with standard
urotherapy.
The effect of treatment will be evaluated after 3 months. Primary endpoint: Resolution of
incontinence after treatment. Secondary endpoint: Improved quality of life after successful
treatment of urinary incontinence.
Study 2:
Aim: To investigate the urofecal microbiome in children with BBD
Materials and methods:
1. A cohort study to investigate, whether the urofecal microbiome can predict response to
treatment and whether it changes during treatment period
2. A case control study to investigate whether the urofecal microbiome is different in
children with BBD and recurrent UTI 's and children with BBD without recurrent UTI 's.
The study population consists of children with BBD included in study 1. A urine-, stool
sample and a perineum swab will be collected from all participants before and after
treatment. Bacterial DNA will be extracted and the microbiome will be determined.
Perspectives:
BBD is a common condition in childhood. It is associated with a considerable psychological
burden and a risk of more severe physical complications.
The studies will provide basic knowledge about characteristics of the BBD patients and
contribute new information about the optimal treatment of BBD children.