To explore the influence of using disposable diapers (DD) on prevalence of pediatric bladder and bowel dysfunction(BBD) and to analyze the relevant factors in Mainland China.

From March 2017 to September 2017, stratified sampling and simple random sampling were used to randomly select 19 kindergartens and 18 primary schools from 12 cities in Mainland China. Using the anonymous questionnaire, 8950 children aged 2 to 8 years were surveyed for epidemiological investigation of BBD. The children number of surveys in each school was more than 200. In order to ensure the accuracy of the questionnaire, the investigators conducted special training for the school head teacher before the investigation. The main contents of the questionnaire include: ①general information (gender, age, height, weight, date of birth, etc.)②using condition of DD after birth (whether DD is used, length of use, number of pieces per day, and whether there are untoward effect, etc.) ③elimination communication (EC) (including potting training, assistant infant’s toilet training)starting time.④current voiding and defecation status, whether to meet the BBD diagnostic criteria.⑤whether or not there is an organic disease that affects urination and defecation. Besides,definition of children's BBD: Children present with lower urinary tract symptoms and defecation dysfunction together, mainly manifested as urinary frequency, urgency, incontinence (sometimes enuresis, droppings, contaminated feces), dysuria, repeated urinary tract infections, constipation or diarrhea, etc. , clinically no evidence of neurological and anatomical organic diseases[1,2,3].SPSS 21.0 statistical software was used for statistical analysis. Qualitative data is expressed as a percentage, and comparisons of multiple groups are conducted using chi-square test and trend chi-square test.The Bonferroni method was used to test the pairwise comparison of the rates between the two groups. The normal distribution of quantitative data was represented by x±s. The mean between groups was compared by t-test and analysis of variance. Multivariate analysis of the incidence of BBD using logistic regression. P <0.05 for the difference was considerate as statistically significant.

A total of 8459 questionnaires are collected (effective collected rate is 94.5%) and 8026 questionnaires are qualified for statistical analysis, of which 4027 are males and 3999 are females. A totalof 219 suffered from BBD from 8026 investigated children aged 2 to 8 years. The overall incidence rate is 2.73%. The incidence rate is different in different age groups (P<0.05)，from 2 to 8 years old, each age is an age group. The trend of Chi-square test shows that the incidence decreases gradually with age (P<0.001),from 4.89% at age 2 to 0.85% at age 8.（P<0.001）(Table 1).The increase of BBD prevalence shows a positive relationship with the usage of DD and delayed EC (including potting training, assistant infant’s toilet training), (P <0.001).When the disposable diaper is used for less than 6 months, the incidence of BBD is 0.95%. However, when the disposable diaper is used for more than 24 months, the incidence of BBD is 6.11%. The incidence of BBD in children who have EC or toilet training within six months is 0.91%. However, when the EC or toilet training starts after 24 months, the incidence of children with BBD is 6.47%. From the birth of the child, the incidence of BBD as a whole has been increasing with the delay of EC.With the prolonged use of disposable diapers, the incidence of BBD increases.Multivariate analysis display using logistic regression showed that the total usage length and the number of DD used per day as well as the obesity are the risk factors for the BBD prevalence in children (OR> 1, P<0.05). EC within 6 months in children is the protective factors for BBD occurrence (OR <1, P<0.05)(Table 2).

The prevalence of BBD gradually decreases with age, however,with the extension length and the increasing amount in the use of disposable diapers, the time for children to initiate elimination communication or toilet training is delayed, resulting in the actual practice of missing children’s early learning self-controlled urination and feces, as well as an increase in the incidence of BBD.

Rational usage of DD and early EC is recommended  for preventing the BBD in children. It is better to begin EC within 6 months of the children’s birth.

Austin PF, Bauer SB, Bower W,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[J].J Urol 2014,191(110):1863-1865.
Beth A. Drzewiecki, John C. Thomas, John C. Pope,et al.Use of Validated Bladder/Bowel Dysfunction Questionnaire in the Clinical Pediatric Urology Setting[J].J Urol 2012,188(036):1578-1583.
Y.F.Rawashdeh, P.Austin,C.Siggaard, et al. International Children's Continence Society's Recommendations for Therapeutic Intervention in Congenital Neuropathic Bladeer and Bowel Dysfunction in Children.   [J]. Neurourology and Urodynamics, 2012(31):615-620.