• Duchenne muscular dystrophy
• voiding

We read with interest the report by MacLeod et al who described urinary symptoms in 46 (62%) of 74 male children with Duchenne muscular dystrophy (DMD).¹

The authors comment that “The neurological basis for this dysfunction is difficult to explain.” Daytime incontinence, urinary frequency, and urgency were reported in 22 (48%), 14 (30%), and 18 (39%) of the 46 boys, respectively. These symptoms suggest the possibility of urge syndrome, a common problem in children that does not have any obvious neurological cause. The pathogenesis of urge syndrome is incompletely understood, but voiding postponement is common in these children and might play an aetiological role.² Voiding postponement is more common in children with neuromuscular disorders because the physical disability impairs access to a bathroom. There are many reasons why access to a bathroom is impaired or why these children might choose to postpone voiding. Wheelchair patients require specialized bathroom facilities and might require assistance, neither of which might be available. Even for “ambulatory” patients, getting on and off a toilet is often a labour-intensive and time-consuming process for many of these children. Requesting assistance for such a personal task might be difficult or embarrassing for some children.

Children with urge syndrome commonly demonstrate squatting behaviour, which is a learned response to minimize incontinence associated with an unwelcome detrusor contraction. Children with DMD have proximal muscle weakness and might be limited in their ability to squat or otherwise to develop muscular strategies to cope with an unwelcome detrusor contraction.