Materials and methods

Results

We found that 72.5% of the children were nine years old and 27.5% were ten, 49.6% were girls, and 50.4% were boys. Among the mothers of the children, 39.7% were high school graduates, and 73% stated their income and expense levels were equivalent. Four-point-seven percent of the children were underweight, 57.9% were of normal weight, 19.6% were overweight, and 17.9% were obese. The rate of incontinence experienced by the children while watching videos was 3.6%.

Some sociodemographic characteristics of the included children and their mothers are presented in table 1. The examination results of the relationship between some sociodemographic characteristics and the VASC, the CBBDQ, and the dimension scores of the participants are shown in table 1. No significant difference was found between the children’s total VASC and CBBDQ and dimension scores based on their age (p > 0.05). The total VASC scores of the boys and their self-control, reward-reinforcement, problems, and involvement dimension scores were significantly higher than the scores of the girls (p < 0.05). Comparing maternal education levels, the VASC total, rewardreinforcement dimension, and involvement dimension scores of the children with high school graduate mothers were significantly lower than to those of children with primary-middle school or university graduate mothers. The VASC total and self-control dimension scores of the children whose families had lower income levels were higher (table 1). The median bowel subscale score of the children with primary-middle education mothers was significantly higher than that of children with high school education mothers. Bladder and bowel symptoms were significantly higher in children whose mothers had lower income than expense levels (p < 0.05).

As shown in tables 1 and 2, a statistically significant relationship was found between urinary/fecal incontinence while watching videos and the total VASC, self-control dimension, problems dimension, total CBBDQ, and bladder subscale scores of the participants (p < 0.001). The children who had a meal or snack while watching videos had significantly higher total VASC, self-control, reward-reinforcement, problems, and involvement scores (p < 0.05) (table 1). Overweight children had more bladder symptoms compared to normal-weight children (table 2).

The total VASC and CBBDQ, and dimension mean scores of the participants are shown in table 3. The VASC mean score of the children was 50.77 ± 16.17, whereas the CBBDQ mean score of the mothers was 29.98 ± 8.90. The ratio of children with a mean score equal to or greater than 90 on VASC was 0.8% (n = 3).

A weak positive correlation was found between the VASC scores of the participants and their CBBDQ (r = 0.220; p = 0.000), bladder subscale (r = 0.202; p = 0.000), and bowel subscale (r = 0.168; p = 0.001) scores (table 3).

Discussion

In this section, the relationship between children’s video game viewing habits and bladder/bowel dysfunctions is discussed based on the literature. The associations between some characteristics of the participants and their VASC total and dimension scores are shown in table 1. The mean total VASC score of the boys was 54.63 ± 16.26, the mean total VASC score of the girls was 46.85 ± 15.15, and the difference between them was significant.

This result was one of the remarkable findings of the study. In the study conducted by De Pasquale et al. (2021), the mean total VASC score was 51.63 for boys and 42.20 for girls ¹⁷. Many studies examining video game addiction have supported our result, and a relationship between the male gender and higher VASC scores has been reported ^18-20. In contrast, another study found that girls had higher scores and were more at risk of addiction ²¹. In our sample, three male children (0.8%) scored 90 or above and should be examined in detail in terms of addiction. In the study carried out by Oflu and Yalçin (2019) using VASC, they reported four children with a score of 90 or above (1.6%), all of them were boys ²². Apparently, boys are more prone to video game addiction, probably explained by different physical, psychological, and personality traits between boys and girls.

There were significant relationships between the VASC scores of the children and the education levels of their mothers, the income levels of their families, their body mass index (BMI) category, their statuses of eating or snacking while watching videos, and their experiences of urinary/fecal incontinence while watching videos (table 1). Previous studies showed that as the education and income levels of the mother’s decrease, their children’s time using the internet and playing video games increases ^23,24. This result may be associated with the mothers’ lack of knowledge about the dangers of prolonged use of technology. Similar to this result, in the literature, snacking on sweet and high-calorie foods during the time spent on sedentary activities such as watching TV, computer, and internet use increased the risk of obesity ^25,26.

A significant relationship was determined between the CBBDQ scores of the participants and their experiences of urinary/fecal incontinence while watching videos (table 2). Significant associations have been found in previous studies between playing video games for prolonged periods and high levels of depression, aggression, trait anxiety, emotional instability, impaired family communication, loss of appetite, sleep disorders, and behaviors of neglecting or being reluctant to take part in physical activities ^27-29.

In addition to the problems observed in previous studies, child’s prolonged presence in front of a screen causes a decrease in their physical activity levels and delays in their urination/defecation. In our study, the ratio of children experiencing urinary incontinence while watching videos was 3.6%, which is worth noting. In a prevalence study, day-night incontinence and constipation were the most common symptoms of bladder-bowel dysfunction, and the postponement of urination/defecation by children who intentionally squeeze their sphincters despite needing to urinate contributed to the development of bladder-bowel dysfunction ^15,30. Children at risk should be referred to the relevant units and analyzed physically and psychologically.

The relationship between the VASC and CBBDQ scores of the participants was analyzed with a correlation analysis. We found significant positive relationships between the VASC self-control and total CBBDQ and bladder subscale scores; and between total VASC and problems dimension scores (table 3). As the time of screen use increases, children sleep less, their blood pressure increases, their HDL cholesterol levels decrease, and insulin resistance increases, causing visual disorders, obesity, and many other health problems associated with inactivity ³¹. Furthermore, there is also a decrease in children’s school success due to decreased attention and memory capacity ³².

In this study, we examined the relationships between excretion status and video game addiction and observed that video game addiction adversely affected excretion. Parents should impose time limitations on children’s technology use. We think being in front of a screen for a long time affects the excretory system, and the child delays going to the toilet. Physical activity should be encouraged in children to discharge their energy.

The results of this study can be generalized to children studying at the schools where we collected the data. It is difficult to measure video game addiction. The measurements in this study were performed based on the children self-reports. The children’s BMI values were calculated according to the height and weight information provided by them and their parents. The inability of the researchers to measure children’s height and weight was among the limitations of the study. Since primary and secondary schools are separated, we included only children in the 9-10 years age group from primary schools. The study’s strength is being the first study to examine the relationship between bladder and bowel dysfunction and video game addiction in children.

In this study, the ratio of children who experienced urinary/fecal incontinence while playing video games was significant, and it was a remarkable result that all three children at risk of video game addiction were male. Increased video game addiction scores were associated with increased bladder and bowel dysfunction scores.

These results will help understanding the impact of video game addiction on bladder and bowel dysfunction by drawing a framework. Furthermore, the resulting evidence showed variables affecting both video game addiction and bladder/bowel dysfunction. We think that interventions should be made to reduce video game addiction, which was the independent variable in this study. Accordingly, it is important to provide awareness training for children and parents on video game playing duration, healthy internet use, and the harms of internet addiction.

A detailed evaluation of children’s video game habits and potential bladder-bowel dysfunction patterns, identifying at-risk children, and directing them to the relevant units are extremely important for the prevention of health conditions that may adversely affect their lives. Moreover, schools should contribute to the children’s physical and mental health development by organizing after-school activities that support their development (e.g., physical activities or active games). We recommend conducting studies to evaluate different intervention effects in children at risk, such as education and counseling programs.