Trends in Toilet Training and Voiding Habits among Children with Down Syndrome

J Urol. 2015 Sep;194(3):783-7. doi: 10.1016/j.juro.2015.03.114. Epub 2015 Apr 4.


Purpose: Children with Down syndrome are at risk for lower urinary tract dysfunction and delayed toilet training. Comparative studies regarding voiding function in the Down syndrome population are lacking. We assessed urinary continence and voiding function in patients with Down syndrome and a control group.

Materials and methods: A questionnaire designed to assess toilet training, continence status, symptoms of lower urinary tract dysfunction and prior evaluation of urological complaints was sent to parents of 326 children with Down syndrome who had been seen at our institution previously. The same survey was administered to parents of patients without Down syndrome. Data were compiled, and descriptive and comparative statistical analyses were performed.

Results: A total of 77 patients comprised the Down syndrome group and 78 patients without Down syndrome comprised the control group. Average age of reported toilet training completion was 5.5 years in children with Down syndrome and 2.2 years in controls. Of children 5 years or older 79% with Down syndrome were toilet trained, compared to 100% of those without Down syndrome. Incontinence was reported in 46% of previously toilet trained children with Down syndrome and 24.5% of controls. These findings were statistically significant. No significant difference was observed in the rate of urinary tract infection, symptoms of lower urinary tract dysfunction or evaluation for urological complaints.

Conclusions: Children with Down syndrome can experience marked delay in toilet training and are more likely to suffer incontinence afterward. This study was ineffective in determining whether symptoms of lower urinary tract dysfunction could be related to decreased continence rates.

Keywords: Down syndrome; lower urinary tract symptoms; toilet training; urinary incontinence.

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Child, Preschool
  • Down Syndrome / complications
  • Down Syndrome / physiopathology*
  • Female
  • Habits
  • Humans
  • Infant
  • Lower Urinary Tract Symptoms / etiology
  • Male
  • Surveys and Questionnaires
  • Toilet Training*
  • Urinary Incontinence / etiology
  • Urination*
  • Young Adult