Article Text

Daytime dehydration in urine incontinent children'is it present and how easily can we detect it in a community setting?
  1. S Postings
  1. Childrens Services, Telford and Wrekin NHS Community Health Services, Shrewsbury, UK


Background Childrens' daytime drinking practices may cause a chronic low grade dehydrated state, resulting in a low functional bladder capacity, production of concentrated urine and evening polydipsia.1 As underlying causes of bladder incontinence, can we prevent this using a urine colour chart2 (UCC)? Using a UCC is a novel way of studying the relationship between dehydration and wetting in children in the community.

Aims To evaluate (1) the introduction and usefulness of a UCC for detecting dehydration, and (2) establish the presence of daytime dehydration in incontinent children.

Methods A non-randomised interventional study with controls, using a qualitative method (5 point Likert Scale structured questionnaire) for analysis. Primary school children, suffering from incontinence, were recruited from attendees at our countywide community enuresis clinics, from August to December 2008. Participants were selected to either receive the UCC (cases) or act as controls, depending on which clinic they attended.

Results 27 cases and 21 controls were recruited. Everyone used the UCC and 91% agreed it was easy to use. Over 86% were confident in their assessment of urine colour and similar numbers were unaware of their child's drinking practices prior to using the UCC. 71% gave urine colour as the reason for altering intake. 50% of the measurements were in the dehydrated range. Of the 10 children with isolated night-time wetting, eight were dehydrated the majority of the time, and in five this improved. Using the UCC resulted in a significant reduction in the number of wet days at 4 weeks z=−2.000, p=0.046, and in the number of wet nights at 4 and 8 weeks z=−2.210, p=0.027 and z=−2.659, p=0.008, respectively. Over the 8 weeks however, no statistical difference was seen when comparing for complete day or night dryness.

Conclusion A UCC is an acceptable means of detecting the presence of dehydration in the community and leads to early improvement in the incontinence. Future research should look at the effect of preventing daytime dehydration on long-term incontinence outcomes.

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