The association of daily urinary and bowel incontinence with emotional functioning in young adults with spina bifida: an ecological momentary assessment study

OBJECTIVE: Urinary and bowel incontinence are common in young adults with spina bifida and may affect emotional functioning and health-related quality of life. Prospective data describing day-level incontinence experiences in this population are limited. This study used ecological momentary assessment to characterize daily variability in urinary and bowel incontinence and to examine associations with mood, incontinence-related anxiety, and health-related quality of life. METHODS: In a 30-day ecological momentary assessment study of adults with spina bifida and recent incontinence, young adults with spina bifida (n = 23; ages 18-26) completed 643 end-of-day assessments. Daily measures included urinary and bowel incontinence frequency, amount, dry intervals, management independence, activity avoidance, positive and negative mood, and incontinence-related anxiety. Health-related quality of life was assessed at study completion. Analyses were exploratory and used nonparametric methods appropriate for ordinal and intensive repeated measures data. RESULTS: Urinary incontinence was reported on 54.1% of study days and bowel incontinence on 20.8%. For urinary incontinence, greater frequency, shorter dry intervals, larger amounts, and activity avoidance were associated with lower positive mood, higher negative mood, and greater urinary incontinence-related anxiety. For bowel incontinence, greater symptom severity, management dependence, and activity avoidance were associated with poorer mood and higher bowel incontinence-related anxiety. Multiple day-level incontinence characteristics and daily emotional responses were associated with lower end-of-month health-related quality of life. CONCLUSION: In young adults with spina bifida, day-level incontinence burden is associated with same-day emotional functioning and longer-term health-related quality of life. These findings highlight the relevance of day-level symptom variability for rehabilitation assessment and individualized continence management.