Twijfelt u soms om leerlingen tijdens de les naar het toilet te laten gaan? Vermijd uitstel en speel als leerkracht een grote rol in de preventie van plasproblemen.
We gingen na hoe vaak plasproblemen voorkomen bij kinderen in vier Vlaamse lagere scholen. Uit onze scriptie bleek één op tien urinewegklachten te hebben. Wat overeenstemt met internationale bevindingen. Reden genoeg dus om deze klachten aan te pakken.
Aangezien urinewegproblemen vaak gepaard gaan met negatieve gevolgen, bekeken we ook het welbevinden van de leerlingen. Dit gingen we na via vragenlijsten, bij zowel de ouders als de kinderen.
De impact van plasproblemen?
Voorafgaand aan het onderzoek werd een literatuurstudie uitgevoerd. Eerst een woordje uitleg over het begrip ‘plasprobleem’. De meest gekende symptomen bij kinderen zijn broek- en bedplassen. Daarnaast zijn er ook een aantal “mildere”, minder gekende kenmerken. Dit kunnen één van de volgende klachten zijn: plots heel dringend moeten plassen, vaak moeten plassen, ophoudmanoeuvres of pijn. Wij vonden dat drang om te plassen en ophoudmanoeuvres het meeste aanwezig waren.
Vaak komen deze symptomen samen voor of gaan ze gepaard met een stoelgang problematiek zoals constipatie. Verder kunnen deze klachten een impact hebben op het dagdagelijkse leven. Kinderen met ontwikkelingsstoornissen, zoals autisme of ADHD, hebben meer kans op plas- of stoelgangproblemen.
De impact uit zich het meest op het sociaal- en psychologisch functioneren. Kinderen die bedplassen gaan minder snel deelnemen aan kampen met overnachtingen. Andere uitingen zijn sociale vermijding of een slechter mentaal welbevinden, door stress of angst. Uit de resultaten van onze scriptie bleek dat de klachten het meeste invloed hadden op de tevredenheid van de kinderen binnen de schoolomgeving. De kinderen geven aan zich minder goed te voelen in de klas en op school.
Mildere symptomen worden niet altijd erkend, ondanks de negatieve impact op het welbevinden. Vaak gaan plasproblemen ook gepaard met hogere financiële kosten door de medische opvolging en hygiënische producten.
En nu… de aanpak!
Zowel ter preventie als tijdens de behandeling van aanwezige klachten is nauwe samenwerking met de school cruciaal. Onvoldoende erkenning door de omgeving kan zorgen voor de nodige emotionele stress. Hierdoor kan het kind zich minder goed voelen op school, wat zijn weerslag kan hebben op het schools functioneren. Plaats voor educatie op school is de eerste stap. Herkenning en kennis kan ervoor zorgen dat klachten sneller worden aangekaart, waardoor kinderen sneller de nodige hulp krijgen.
Tijdens de behandeling moeten specifieke adviezen zowel thuis als op school worden opgevolgd. Kinderen moeten de kans krijgen om tijdens de lesuren naar het toilet te gaan. Daarnaast kunnen acties op school worden georganiseerd om leerlingen genoeg water te laten drinken en drinkbaar water op verschillende plaatsen te voorzien. Specifiek voor kinderen met plasproblemen is het belangrijk dat leerkrachten hen ondersteunen bij het behandelproces.
5 tips voor leerkrachten
Is er toch verdere hulp nodig? Verwijs het kind door naar de kinderarts, uroloog, gastro-enteroloog of nefroloog in het ziekenhuis.
1. de Jong, T.P.V.M., A.J. Klijn, and M.A.W. Vijverberg, Lower Urinary Tract Dysfunction in Children. European Urology Supplements, 2012. 11(2): p. 10-15.
2. Vaz, G.T., et al., Prevalence of lower urinary tract symptoms in school-age children. Pediatric Nephrology, 2012. 27(4): p. 597-603.
3. Somoza Argibay, I., et al., [Urinary incontinence and lower urinary tract dysfunction prevalence in schoolchildren: risk factors]. Cirugia pediatrica : organo oficial de la Sociedad Espanola de Cirugia Pediatrica, 2019. 32(3): p. 145-149.
4. Austin, P.F., et al., The standardization of terminology of lower urinary tract function in children and adolescents: Update report from the standardization committee of the International Children's Continence Society. Neurourology and urodynamics, 2016. 35(4): p. 471-81.
5. Drake, M.J., Fundamentals of terminology in lower urinary tract function. Neurourology and Urodynamics, 2018. 37(S6): p. S13-S19.
6. t Hoen, L.A., et al., Vancouver Symptom Score for Dysfunctional Elimination Syndrome: Reliability and Validity of the Dutch Version. The Journal of urology, 2016. 196(2): p. 536-41.
7. Brady, S.S., et al., The Prevention of Lower Urinary Tract Symptoms (PLUS) in girls and women: Developing a conceptual framework for a prevention research agenda. Neurourology and urodynamics, 2018. 37(8): p. 2951-2964.
8. Lundblad, B. and A.L. Hellström, Perceptions of school toilets as a cause for irregular toilet habits among schoolchildren aged 6 to 16 years. The Journal of school health, 2005. 75(4): p. 125-8.
9. Ko, L.N., et al., Lower Urinary Tract Dysfunction in Elementary School Children: Results of a Cross-Sectional Teacher Survey. The Journal of urology, 2016. 195(4 Pt 2): p. 1232-1238.
10. Nieuwhof-Leppink, A.J., et al., Definitions, indications and practice of urotherapy in children and adolescents: - A standardization document of the International Children's Continence Society (ICCS). Journal of Pediatric Urology, 2021. 17(2): p. 172-181.
11. Didsbury, M.S., et al., Socio-economic status and quality of life in children with chronic disease: A systematic review. Journal of paediatrics and child health, 2016. 52(12): p. 1062-1069.
12. Skevington, S.M., Measuring quality of life in britain: Introducing the WHOQOL-100. Journal of Psychosomatic Research, 1999. 47(5): p. 449-459.
13. Van Herzeele, C., et al., Challenging factors for enuresis treatment: Psychological problems and non-adherence. Journal of pediatric urology, 2015. 11(6): p. 308-13.
14. Cohen-Zrubavel, V., et al., Sleep and sleepiness in children with nocturnal enuresis. Sleep, 2011. 34(2): p. 191-4.
15. Tsuji, S., et al., Nocturnal enuresis and poor sleep quality. Pediatrics international : official journal of the Japan Pediatric Society, 2018. 60(11): p. 1020-1023.
16. Butler, R.J., E.J. Redfern, and W.I. Forsythe, The child's construing of nocturnal enuresis: a method of inquiry and prediction of outcome. Journal of child psychology and psychiatry, and allied disciplines, 1990. 31(3): p. 447-54.
17. Marciano, R.C., et al., Behavioral disorders and impairment of quality of life in children and adolescents with lower urinary tract dysfunction. Journal of pediatric urology, 2018. 14(6): p. 568.e1-568.e7.
18. Whale, K., H. Cramer, and C. Joinson, 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): p. 253-277.
19. Cederblad, M., et al., "Nobody asked us if we needed help": Swedish parents experiences of enuresis. Journal of pediatric urology, 2014. 10(1): p. 74-9.
20. Kanaheswari, Y., et al., Self-esteem in 6- to 16-year-olds with monosymptomatic nocturnal enuresis. Journal of paediatrics and child health, 2012. 48(10): p. E178-82.
21. Ertan, P., et al., Relationship of sleep quality and quality of life in children with monosymptomatic enuresis. Child: care, health and development, 2009. 35(4): p. 469-74.
22. Gladh, G., M. Eldh, and S. Mattsson, Quality of life in neurologically healthy children with urinary incontinence. Acta paediatrica (Oslo, Norway : 1992), 2006. 95(12): p. 1648-52.
23. Jönson Ring, I., et al., Nocturnal enuresis impaired children's quality of life and friendships. Acta paediatrica (Oslo, Norway : 1992), 2017. 106(5): p. 806-811.
24. Gulisano, M., et al., Importance of neuropsychiatric evaluation in children with primary monosymptomatic enuresis. Journal of pediatric urology, 2017. 13(1): p. 36.e1-36.e6.
25. Theunis, M., et al., Self-image and performance in children with nocturnal enuresis. European urology, 2002. 41(6): p. 660-7; discussion 667.
26. Bower, W.F., Self-reported effect of childhood incontinence on quality of life. Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society, 2008. 35(6): p. 617-21.
27. Butler, R.J., C.R. Brewin, and W.I. Forsythe, Maternal attributions and tolerance for nocturnal enuresis. Behaviour Research and Therapy, 1986. 24(3): p. 307-312.
28. Hägglöf, B., et al., Self-esteem in children with nocturnal enuresis and urinary incontinence: improvement of self-esteem after treatment. European urology, 1998. 33 Suppl 3: p. 16-9.
29. Lindert, J., et al., Well-being measurement and the WHO health policy Health 2010: systematic review of measurement scales. European journal of public health, 2015. 25(4): p. 731-40.
30. Konu, A. and M. Rimpelä, Well-being in schools: a conceptual model. Health promotion international, 2002. 17(1): p. 79-87.
31. Wolraich, M.L., et al., Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics, 2019. 144(4).
32. Dos Santos, J., R.I. Lopes, and M.A. Koyle, Bladder and bowel dysfunction in children: an update on the diagnosis and treatment of a common, but underdiagnosed pediatric problem. Canadian Urological Association Journal, 2017. 11(1-2S): p. S64-72.
33. Mahjani, B., et al., Systematic review and meta-analysis: relationships between attention-deficit/hyperactivity disorder and urinary symptoms in children. European child & adolescent psychiatry, 2022. 31(4): p. 663-670.
34. Joinson, C., et al., Early childhood risk factors associated with daytime wetting and soiling in school-age children. Journal of pediatric psychology, 2008. 33(7): p. 739-50.
35. Logan, B.A., et al., Voiding dysfunction related to adverse childhood experiences and neuropsychiatric disorders. Journal of pediatric urology, 2014. 10(4): p. 634-638.
36. Geuze, R.H., M.M. Schoemaker, and B. Smits-Engelsman, Clinical and research criteria for developmental coordination disorder—should they be one and the same? Current Developmental Disorders Reports, 2015. 2(2): p. 127-130.
37. Morris-Rosendahl, D.J. and M.-A. Crocq, Neurodevelopmental disorders—the history and future of a diagnostic concept. Dialogues in clinical neuroscience, 2022.
38. Blank, R., et al., International clinical practice recommendations on the definition, diagnosis, assessment, intervention, and psychosocial aspects of developmental coordination disorder. Developmental Medicine & Child Neurology, 2019. 61(3): p. 242-285.
39. Farmer, M., B. Echenne, and R. Drouin, Insights in developmental coordination disorder. Current pediatric reviews, 2017. 13(2): p. 111-119.
40. Operto, F.F., et al., Neuropsychological Profile, Emotional/Behavioral Problems, and Parental Stress in Children with Neurodevelopmental Disorders. Brain Sciences, 2021. 11(5): p. 584.
41. Missiuna, C., et al., Psychological distress in children with developmental coordination disorder and attention-deficit hyperactivity disorder. Research in developmental disabilities, 2014. 35(5): p. 1198-1207.
42. von Elm, E., et al., The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for reporting observational studies. International Journal of Surgery, 2014. 12(12): p. 1495-1499.
43. De Lee, L. and I. De Volder, Bevraging van het welbevinden bij leerlingen in het basisonderwijs. Universiteit Antwerpen: niet-gepubliceerde masterscriptie, 2009.
44. Schoemaker, M.M., et al., Evaluation of the Developmental Coordination Disorder Questionnaire as a screening instrument. Developmental medicine and child neurology, 2006. 48(8): p. 668-673.
45. Franco, I., Overactive bladder in children. Nature Reviews Urology, 2016. 13(9): p. 520-532.
46. Xing, D., et al., Prevalence and risk factors of overactive bladder in Chinese children: A population-based study. Neurourology and Urodynamics, 2020. 39(2): p. 688-694.
47. Loening-Baucke, V., Prevalence rates for constipation and faecal and urinary incontinence. Archives of disease in childhood, 2007. 92(6): p. 486-9.
48. Burgers, R.E., et al., Management of Functional Constipation in Children with Lower Urinary Tract Symptoms: Report from the Standardization Committee of the International Children's Continence Society. The Journal of Urology, 2013. 190(1): p. 29-36.
49. Schast, A.P., et al., Quantifying demographic, urological and behavioral characteristics of children with lower urinary tract symptoms. Journal of pediatric urology, 2008. 4(2): p. 127-33.
50. Shim, J. and M.M. Oh, Updates of Overactive Bladder in Pediatrics. International neurourology journal, 2023. 27(1): p. 3-14.
51. Chandra, M. and K. Merchant, Voiding Disorders in Children. Current Treatment Options in Pediatrics, 2022. 8(2): p. 19-37.
52. Apostolidis, A., et al., Is there "brain OAB" and how can we recognize it? International Consultation on Incontinence-Research Society (ICI-RS) 2017. Neurourology and urodynamics, 2018. 37(S4): p. S38-s45.
53. Ozden, C., et al., Prevalence and associated factors of enuresis in Turkish children. International braz j urol : official journal of the Brazilian Society of Urology, 2007. 33(2): p. 216-22.
54. Ballek, N.K. and P.H. McKenna, Lower urinary tract dysfunction in childhood. Urologic Clinics, 2010. 37(2): p. 215-228.
55. Iscan, B. and N. Ozkayın, Evaluation of health-related quality of life and affecting factors in child with enuresis. Journal of pediatric urology, 2020. 16(2): p. 195.e1-195.e7.
56. von Gontard, A., et al., Neurodevelopmental disorders and incontinence in children and adolescents: Attention-deficit/hyperactivity disorder, autism spectrum disorder, and intellectual disability-A consensus document of the International Children's Continence Society. Neurourology and urodynamics, 2022. 41(1): p. 102-114.
57. Vasconcelos, M.M.A., et al., Association between Attention Deficit Hyperactivity Disorder and lower urinary tract symptoms in children and adolescents in a community setting. International braz j urol : official journal of the Brazilian Society of Urology, 2021. 47(5): p. 969-978.
58. von Gontard, A., et al., Incontinence in children with autism spectrum disorder. Journal of Pediatric Urology, 2015. 11(5): p. 264.e1-264.e7.
59. Price, K. and U. Butler, Bowel and bladder management in children with disabilities. Current Paediatrics, 2001. 11(2): p. 143-148.
60. Kirby, A., L. Edwards, and A. Hughes, Parents' concerns about children with specific learning difficulties: Insights gained from an online message centre. Support for Learning, 2008. 23: p. 193-200.
61. Mikami, M., et al., Atypical Sensory Processing Profiles and Their Associations With Motor Problems In Preschoolers With Developmental Coordination Disorder. Child psychiatry and human development, 2021. 52(2): p. 311-320.
62. Omer, S., A.M. Jijon, and H.C. Leonard, Research Review: Internalising symptoms in developmental coordination disorder: a systematic review and meta-analysis. Journal of Child Psychology and Psychiatry, 2019. 60(6): p. 606-621.
63. Biotteau, M., J.M. Albaret, and Y. Chaix, Developmental coordination disorder. Handbook of clinical neurology, 2020. 174: p. 3-20.
64. Wilson, B.N., et al., Psychometric properties of the revised developmental coordination disorder questionnaire. Physical & occupational therapy in pediatrics, 2009. 29(2): p. 182-202.
65. Theunissen, N.C.M., et al., The Proxy Problem: Child Report versus Parent Report in Health-Related Quality of Life Research. Quality of Life Research, 1998. 7(5): p. 387-397.