B4048 - Prospective relationships between incontinence and common mental health problems in adolescents from a UK cohort - 20/04/2022

B number: 
Principal applicant name: 
Carol Joinson | PHS (UK)
Dr Naomi Warne, Katie Gordon
Title of project: 
Prospective relationships between incontinence and common mental health problems in adolescents from a UK cohort
Proposal summary: 

Incontinence – both urinary and faecal – is a common childhood occurrence. Whilst most children obtain daytime bladder control by 3-years, and night-time bladder control at 4-6-years, it is not uncommon for school-age children to experience some form of incontinence (1). Indeed, parents of 7 ½ year-olds in the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort reported 15.5% experienced bedwetting, and 7.6% experienced daytime wetting. Incontinence can seriously undermine quality of life, and psychological distress may occur if children become aware that incontinence is unusual for children of their age and/or following negative reactions from family or peers (1). Further, 20-40% of children in attendance of continence clinics meet diagnostic criteria of at least one psychiatric condition (2).

It is commonly believed that issues with continence during childhood will resolve with age (3). However, epidemiological studies report 2-3% of adolescents experience urinary incontinence, and 1-1.5% experience faecal incontinence (3). There is also evidence that adolescents experience more severe forms of incontinence compared to younger children. Indeed, a cross-sectional study of 16,512 children in Hong Kong found a greater proportion of frequent bedwetting (≥3 wet nights/week) accompanied with daytime wetting and other lower urinary tract symptoms in 11-19-year olds compared to 5-10-year olds (4).

Incontinence in adolescence is particularly problematic because this is a sensitive time period in which identity and body image are formed, and peer acceptance is highly valued (1). The shame and stigma associated with incontinence may affect friendships and participation in social activities, which may in turn increase risk of developing psychosocial problems. Psychosocial problems during adolescence have been linked to future adverse mental health and social outcomes, including poor academic attainment, low self-esteem, depression, and suicidal behaviours (1,3).

Whilst some studies have investigated whether childhood incontinence is a risk factor for poor psychosocial outcomes in adolescence, few consider the impact of incontinence issues that persist beyond childhood. Further research is therefore required to investigate the relationship between continence issues in adolescence and adverse mental health outcomes.

1. Grzeda MT, Heron J, von Gontard A, Joinson C. Effects of urinary incontinence on psychosocial outcomes in adolescence. European Child and Adolescent Psychiatry. 2017 Jun;26(6):649–58.
2. Heron J, Grzeda MT, von Gontard A, Wright A, Joinson C. Trajectories of urinary incontinence in childhood and bladder and bowel symptoms in adolescence: prospective cohort study. BMJ Open. 2017;7(3):e014238.
3. Whale K, Cramer H, Joinson C. Left behind and left out: The impact of the school environment on young people with continence problems. British Journal of Health Psychology. 2018;23(2):253–77.
4. Yeung CK, Sreedhar B, Sihoe JDY, Sit FKY, Lau J. Differences in characteristics of nocturnal enuresis between children and adolescents: a critical appraisal from a large epidemiological study. BJU International. 2006;97(5):1069–73.

Impact of research: 
This masters project is part of a wider MRC project examining bidirectional relationships between incontinence and mental health. The findings will help to raise awareness of the need for psychological support for young people with continence issues.
Date proposal received: 
Monday, 11 April, 2022
Date proposal approved: 
Wednesday, 20 April, 2022
Epidemiology, Incontinence, Statistical methods, Development