The effects of toilet training age, voiding position and toilet type preference on the bladder dysfunction development

Bladder dysfunction is one of the most common voiding problems in childhood. Functional causes are more frequent than anatomical, neurological and other causes. Somatic, psychosocial and environmental factors have been shown to play a role in the etiopathogenesis of functional voiding dysfunction in various studies. In the present study, we aimed to investigate whether the age of toilet training, voiding position and toilet type preference have an effect on the development of bladder dysfunction. Accordingly, 150 children with a diagnosis of bladder dysfunction, and 300 healthy children aged between 5 and 18 years of age without symptoms of lower urinary tract were included in the study. The data of the patient group were evaluated retrospectively. Patients with anatomical or neurological problems and those with incomplete data were excluded from the study. The mean ages of the patient group and the control group were 96.7 ± 30.5 months and 110.7 ± 37.5 months, respectively. The gender distribution of the control group was homogeneous (51% female, 49% male); however, 64% of the patients were female. Female gender, family history of urinary incontinence, urine holding / waiting behavior, the duration of toilet training, voiding position and toilet type preference were found to be independent risk factors affecting bladder dysfunction development (all p <0.05). The incidence of bladder dysfunction was found to be 3 times higher in girls and 3.7 times higher in boys using squat-toilet compared to sit-toilet (95% CI: 1.68-5.43, p <0.001; 95% CI: 1.84-7.48, p <0.001, respectively). Squatting voiding was found to increase the probability of bladder dysfunction 3.2 fold in girls (95% CI: 1.77-5.70, p <0.001). On the other hand, the incidence of bladder dysfunction was identified to be 4.9 fold in boys voiding in standing position (95% CI: 1.89-12.5, p = 0.001). No effect of the toilet training age and constipation on the development of bladder dysfunction was found. This study contributes to the literature showing the relationship between bladder dysfunction and both voiding position and toilet type preference in children. We suggest that informing parents and children about toilet preferences would decrease the development of functional bladder dysfunction, and also there is a need of further studies on this subject.