Introduction Bladder dysfunction has been associated with functional chronic constipation and faecal incontinence (CCFI) in children.^{1 2} The pathophysiology of the coexistence of CCFI and urinary incontinence (UI) remains rudimentary. The interaction between the bladder and the anorectum in children, using diagnostic investigations such as high resolution anorectal manometry (HRAM) is unknown. This study aims to investigate the symptomatologic and physiological outcomes in children with CCFI, with UI compared to children without UI.

Methods Patients with functional CCFI who presented to our specialised service from September 2016 to September 2022 were included. Measures included: demographics, bowel scores: St Marks Incontinence Scores (SMIC) and Cleveland Constipation Scores (CCS), HRAM parameters and colonic transit x-rays.

Results Out of 341 patients with functional constipation, 40% (135/341) had UI. There were no significant demographic differences between those with or without UI (table 1). Patients with UI and CCFI, had significantly higher SMIC compared to patients who did not have UI (p<0.001) (figure 1). Patients with UI, significantly had lower mean threshold on maximum squeeze increments (p < 0.05) and endurance squeeze (p <0.05).

Conclusion This is the first study, to demonstrate the outcomes in children with CCFI and UI using HRAM. We have shown:

• Despite normal sphincteric function, children with both CCFI and UI, have abnormal external anal sphincter endurance.

• UI and FI are often managed in isolation with unsatisfactory outcomes.

• It is hoped that simultaneous colorectal and urological specialist input, will improve our understanding and outcomes in children with double incontinence.

• We look forward to reporting on the routine use of urological questionnaires, assessment, investigation, review and follow up.

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Abstract OC4 Figure 1

Comparison of means for bowel cores between groups

References

1. McGrath KH, Caldwell PH, Jones MP. The frequency of constipation in children with nocturnal enuresis: a comparison with parental reporting. J Paed Chi Hea 2008;44:19– 27. 11.

2. Soderstrom U, Hoelcke M, Alenius L. Urinary and faecal incontinence: a population-based study. Acta Paediatr 2004;93:386–9.

3. Nelson CP, Park JM, Bloom A. Incontinence symptoms index-pediatric: development and initial validation of a urinary incontinence instrument for the older pediatric population. The Jnr of Urol. 2007;1763–1767.