Incontinence in Intellectual Disability: An Under Recognized Cause SD01-SD02
Dr. Lal Devayanivasudevan Nair,
4-1, East Mada Street, Srinagar Colony, Saidapet, Chennai-15, India.
Many children with Down syndrome may develop urinary incontinence during adolescence or nearing adulthood. Most often low mental ability, behavioural issues, urinary tract infection, hypothyroidism, atlanto-axial subluxation or sexual abuse may be suspected to be the reason. We report a case of Down syndrome with tethered cord syndrome (TCS) and Lipoma of Filum terminale with Cauda equina in normal position, as a cause of bowel and bladder incontinence. The need for operating with Cauda Equina in normal position is debated. But a conscious decision was taken to operate and the incontinence improved markedly which was documented by using a standardized questionnaire (Kingâ€™s questionnaire) and thereby making a difference in the childâ€™s life. A literature search did not result in any case of Down syndrome with tethered cord syndrome and secondary incontinence as presentation. Considering the possibility of TCS as a cause of incontinence, often neglected even in normal children, careful evaluation and correction of such problems will make a difference in the life of many intellectually disabled children. Incontinence should not be casually attributed to intellectual disability without ruling out other causes.