Child Abuse and Lower Urinary Tract Symptoms: A Systematic Review

BACKGROUND & AIMS: About 25% of children will encounter child abuse throughout their lifetime. Child abuse, one of the main components of adverse childhood experiences (ACEs), is associated with a variety of physical and mental health problems, such as posttraumatic stress disorder, self-injurious behavior, personality disorder, psychosis, sexually transmitted diseases, and lower urinary tract symptoms (LUTS). The aim of this systematic review was to evaluate prevalence and pattern of LUTS both in childhood and adulthood associated to a history of child abuse. METHODS: The systematic review was conducted in accordance with the PRISMA statement. A literature search of the Medline, Scopus, and Web of Science databases was performed in May 2026 and included studies published in English up to April 2026. Relevant studies to the review reported the prevalence and urinary symptoms in child and adult patients who have experienced abuse in childhood primarily. The quality of the studies and risk of bias were evaluated using version 2 of ROBINS-I tool. RESULTS: Out of 676 studies, 19 papers met the inclusion criteria. Six studies explored LUTS in children with past child abuse and neglect, while 13 studies evaluated LUTS in adults with a history of child abuse. Up to 12 years after sexual abuse, abused girls had 2.1 times more diagnoses of urinary problems compared to the general population. In children evaluated for suspected sexual abuse, nocturnal enuresis increased with age, from 13% in 5-9 years to 18.2% in 17-18 years. Childhood traumatic event score was significantly associated with overall LUTS severity and frequency, urgency, and incontinence severity, while ACEs predicted the total number of LUTS. In one study, formal mediation analysis suggested that depression, anxiety, and perceived stress partly mediated the association between childhood trauma and LUTS severity, whereas another study found no mediating effect of negative affect. Limitations of the review are the low quality of studies (13 of 19 retrospective; serious overall risk of bias in 13) and the lack of standardized assessment of abuse and LUTS; overall, the certainty of the evidence is low. CONCLUSION: A history of childhood abuse appears to be associated with LUTS during childhood, which could also manifest in adulthood. However, given the predominantly retrospective design of the included studies and the heterogeneity of abuse definitions and urinary outcomes, the strength of this evidence remains limited.