Bladder and voiding dysfunction in adolescents with anorexia nervosa: a novel finding and potential causes
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ORIGINAL ARTICLE
Bladder and voiding dysfunction in adolescents with anorexia nervosa: a novel finding and potential causes Demet Tas1 · Saniye Ekinci2 · Sinem Akgül3 · Yasemin Düzçeker3 · Orhan Derman3 · Nuray Kanbur3 Received: 23 September 2019 / Accepted: 2 December 2019 © Springer Nature Switzerland AG 2019
Abstract Purpose This study aimed to investigate the bladder capacity (BC) and bladder dynamics of adolescents with anorexia nervosa (AN). Methods The participants consisted of 15 adolescents newly diagnosed with AN according to the DSM 5 criteria and in the acute weight loss period who were questioned about the symptoms of lower urinary tract (LUT) dysfunction. Functional bladder capacity (FBC) and voided volume with uroflowmetry were measured for each subject; the larger volume of the two was chosen for the bladder capacity. Uroflowmetry was used to obtain uroflow curves for the participants whose patterns were labeled as pathologic if they were outside the bell-shape. Results Fourteen (93.3%) of the patients exhibited at least one of the LUT dysfunction symptoms (pathologic voiding symptom/urinary incontinence/pathologic uroflow pattern). BC was observed to increase in 86.6% (n = 13) of the patients. Eighty% of the patients (n = 12) showed pathological uroflow patterns. In patients with pathological uroflow patterns, which showed insufficiency of bladder contraction, assistance of abdominal muscles was needed during voiding. Conclusion The novel findings presented in this study are the increase of BC in adolescents with AN, the presence of at least one type of voiding or bladder dysfunction, and the pathology of uroflow patterns of most patients show that the bladder dynamics is affected in AN. The most important contribution of this study to the literature is that impaired bladder dynamics was determined to be a medical complication of AN. Level of evidence Case–control analytic study, Level III. Keywords Anorexia nervosa · Adolescent · Voiding dysfunction · Bladder dysfunction · Bladder capacity · Uroflow
Introduction Urinary and endocrine system complications of anorexia nervosa (AN) except for the lower urinary tract have been evaluated in the literature [1–3]. Impaired osmoregulation in AN can result in polyuria-induced enuresis. Hypothalamic dysfunction in AN may cause vasopressin secretion disorder in addition to inadequate renal responses to vasopressin due * Nuray Kanbur [email protected] 1
Children Hospital Department of Pediatrics, Ankara City Hospital, Ankara, Turkey
2
Department of Pediatric Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
3
Division of Adolescent Medicine, Department of Pediatrics, Hacettepe University Ihsan Dogramaci Children’s Hospital, Ankara, Turkey
to the depletion of ‘vasopressin V2 receptor’ located in the renal collecting system. The renal damage and/or various electrolyte disturbances in AN as well as serotonin reuptake inhibitors and antipsychotics used in the treatment can also influence osmotic regulation [4–6]. Stu
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