Urinary leakage in the daytime, feeling of urgency to urinate and frequent urination are common and often incapacitating problems in school-aged children. If affects 5-10% of healthy, otherwise normal children and significantly disrupts their day-to-day life and learning.(6,7)  This has consequences for mental health and healthy development.

The symptoms are often associated with significant constipation further adding to the difficulties in care. These problems also result in repeat hospital/ clinic presentations and an escalatory heathcare cost.  Current treatment strategies include bladder specific medications and bladder training. Although the results of the treatment are satisfactory in majority of the children, some children continue to struggle with symptoms. It has been proven that urine contains bacteria even in healthy state and in the absence of any infection.(2) In adult women, changes in the quantity and type of these bacteria have been shown to cause symptoms relatable to the bladder such as urgency and frequency (as mentioned above).(1-4) We believe that an improved understanding using a new paradigm (urinary microbiome analysis) may lead to improved treatment outcomes in children with urinary leakage and urgency and be able to further inform the postulated link between constipation and urinary problems in children.

Aims of the project
This project examines: 1) the possibility of urinary microbiome abnormalities being linked to urinary symptoms in children with overactive bladder and bladder bowel dysfunction; 2) the possibility of differences in fecal microbiome being associated with the urinary microbiome abnormalities.
The aims of this pilot study are:

  • To study and define the baseline abnormalities in the bacteria present in the absence of infection in  the urine and feces (microbiome) in children with bladder bowel dysfunction who may present with symptoms of urgency, frequency and/or urinary leakage
  • To associate the severity of the urinary microbiome abnormalities with those in fecal microbiome; severity of urinary symptoms and severity of constipation.

How we intend to address the problem
We intend to bring together the bladder clinic expertise at the John Hunter Children’s Hospital (AD) with the latest microbiome and immunology experts (PH, AC, MS) and analysis facilities available through the HMRI in this pioneering project. The bladder clinic at the John Hunter Children’s Hospital attends to about 200 children with bladder problems every year. We hope to include the eligible children after obtaining informed consent. We plan to compare the urinary microbiome of children with and without bladder symptoms (controls). We plan to describe the differences that could be associated with the bladder symptoms and explore any differences between those in boys and girls. The results of this pilot study will open new treatment windows in this chronic, vexing problem. We hope to extend the findings of this study to larger, externally funded trials, which will investigate treatment strategies of treatment. It is conceivable that as a result of this study, bladder problems could be addressed through manipulation of the microbiome in the urine and/or the feces in the future.

Project type 
Project Grant
Year of funding