Bladder and Bowel Dysfunction: Evidence for Multidisciplinary Care Cortney Wolfe-Christensen,* Alexandra Manolis, William C. Guy, Natalija Kovacevic, Najeeb Zoubi, Mohammad El-Baba, Larisa G. Kovacevic and Yegappan Lakshmanan From the Department of Pediatric Urology (CW-C, AM, WCG, NK, LGK, YL) and Division of Pediatric Gastroenterology, Department of Pediatrics (NZ, MEl-B), Children’s Hospital of Michigan, Detroit, Michigan Purpose: We examined the symptoms of bladder-bowel dysfunction (ie severity of voiding dysfunction and stool consistency) and psychosocial difficulties in children presenting to the pediatric urology clinic for voiding dysfunction and to the pediatric gastroenterology clinic for functional constipation. Materials and Methods: Parents of children seen at the gastroenterology clinic were recruited during the outpatient clinic appointment, and parents of children seen at the urology clinic were randomly selected from the research database and matched to the gastroenterology sample based on age and gender of the child. All parents completed the Dysfunctional Voiding Scoring System, Bristol Stool Form Scale, Pediatric Symptom Checklist and Parenting Stress IndexÔ-Short Form, which assessed severity of voiding dysfunction, stool consistency, level of psychosocial difficulties and level of parenting stress, respectively. Results: Children seen at the urology and gastroenterology clinics did not differ significantly on any of the measures, indicating that the severity of their bladder- bowel dysfunction is similar. However, they had significantly more severe void- ing dysfunction, more constipated stool and more psychosocial difficulties than historical healthy controls. Additionally, level of parenting stress was signifi- cantly correlated with patient level of psychosocial difficulties and severity of voiding dysfunction. Conclusions: Patients with bladder and bowel dysfunction represent a homo- geneous group that would potentially benefit from a multidisciplinary treatment approach involving urology, gastroenterology and psychology professionals. Key Words: combined modality therapy, constipation, urinary incontinence VOIDING dysfunction comprises almost 40% of referrals to pediatric urolo- gists, 1 while bowel dysfunction lead- ing to functional constipation accounts for approximately 25% to 30% of referrals to pediatric gastroenterolo- gists. 2 While previous reports have indicated a significant overlap in these conditions in primary care settings, with 24% of children with functional fecal retention also reporting daytime incontinence, 3 the prevalence of these comorbid conditions is higher at ter- tiary care centers. It was recently reported that 47% of patients seen at a pediatric urology clinic for lower urinary tract symptoms also met criteria for functional constipation. 4 Children presenting with a combina- tion of bladder and bowel disturbances are now classified as having bladder- bowel dysfunction. Acknowledging the importance of assessing bowel habits in children presenting with lower Abbreviations and Acronyms BSFS ¼ Bristol Stool Form Scale DVSS ¼ Dysfunctional Voiding Scoring System GI ¼ gastroenterology PSC ¼ Pediatric Symptom Checklist PSI-SF ¼ Parenting Stress Index-Short Form Accepted for publication May 6, 2013. Study received institutional review board approval. * Correspondence: Children’s Hospital of Michigan, 3901 Beaubien St., Detroit, Michigan 48201 (telephone: 313-745-5588; FAX: 313-993- 8738; e-mail: cbwolfe@dmc.org ). 1864 j www.jurology.com 0022-5347/13/1905-1864/0 THE JOURNAL OF UROLOGY ® © 2013 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION AND RESEARCH,INC. http://dx.doi.org/10.1016/j.juro.2013.05.012 Vol. 190, 1864-1868, November 2013 Printed in U.S.A.