What evidence do we need to improve the attainment of bladder and bowel control in children and prevent negative sequelae in adolescence and adult life? ICI-RS 2025

Abstract

Aims Nocturnal enuresis (NE), daytime urinary incontinence (DUI), and fecal incontinence (FI) and functional constipation (FC) are common functional disorders in childhood, which can persist into adolescence and adulthood. The aim of this paper is to review evidence of risk factors that impede the attainment of bladder/bowel control and contribute towards the persistence of incontinence, and to outline protective factors towards minimizing long-term negative sequelae.Methods A think tank group consisting of multidisciplinary experts at the International Consultation on Incontinence Research Society (ICI-RS) in 2025 reviewed evidence of factors influencing the attainment of bladder and bowel control, the continuation of incontinence into adolescence and adulthood and the subsequent negative sequelae. Both prospective and retrospective views were considered. Open questions and future directions were discussed. Recommendations for future research and for the improvement of clinical practice in in children, adolescents and adults were formulated.Results Childhood incontinence can continue into adolescence and adulthood and is associated with medical and mental health risks. Genetic and environmental risk factors have been identified, but their interaction with protective factors has not been studied. Potentially important environmental risks that require further research include late toilet training, prolonged use of disposable diapers, excessive use of digital media and lack of transitional care from pediatric to adult services. Studies on prevention on all levels (universal, selective and indicated) are lacking.Conclusions As childhood incontinence is a precursor of adult incontinence in many patients, early preventive measures are needed. Future research should focus on identifying risk and protective factors. Improved collaboration and exchange between pediatric services and adult urology is essential.