Impact of urinary incontinence on self-concept in children with spina bifida

Purpose: Low self-concept and self-esteem are thought to be the main predictors of psychological problems in children and adolescents. Children with Spina bifida are thought to be at an increased risk for low self-concept and self-esteem given their disabilities. We examined the impact of urinary continence on self-concept in children with myelomeningocele. Materials and Methods: A total of 50 patients 7 to 19 years old with Spina bifida were evaluated using the Hartner self-perception profile. Each patient was asked to self-rate on a scale of 1 to 4 using specific domains of self-concept, including scholastic competence, social acceptance, athletic competence, physical appearance, behavioral conduct and global self-worth. Continence and several other factors, namely ambulatory status, family situation and insurance status, were reviewed simultaneously. Results: There were no statistically significant differences between continent patients with Spina bifida and controls. Overall children with Spina bifida rated lower in scholastic competence, social acceptance and behavioral conduct than controls. Girls with Spina bifida scored lower in perceived athleticism, physical appearance and global self-worth than boys with Spina bifida. Continent girls were self-rated higher in social acceptance and global self-worth than incontinent girls. Continent boys were self-rated higher in scholastic competence, social acceptance, physical appearance and behavior compared to incontinent boys. Conclusions: Continence is associated with better self-concept in children with Spina bifida and incontinent girls are at particularly high risk for poor self-esteem. Urologists' efforts to promote continence are likely to have a positive effect on self-concept in boys and girls with Spina bifida.