Abstract
Purpose:
We provide an overview of the psychological and psychiatric aspects of nocturnal enuresis, urinary and fecal incontinence. Clinical behavioral disorders and subclinical psychological symptoms are reviewed. Aspects of screening, assessment, counseling and in severe cases treatment are outlined, and recommendations are formulated.
Materials and Methods:
Relevant publications on psychological and psychiatric aspects are reviewed. The recommendations passed several rounds of consensus finding, and were circulated among International Children's Continence Society members and external experts.
Results:
In addition to subclinical effects on self-esteem, quality of life and distress, the rate of comorbid clinical behavioral disorders is increased. In fact, 20% to 30% of children with nocturnal enuresis, 20% to 40% with daytime urinary incontinence and 30% to 50% with fecal incontinence fulfill the criteria for ICD-10 or Diagnostic and Statistical Manual of Mental Disorders IV psychiatric disorders. These concomitant disturbances require assessment and counseling, and in severe cases treatment. They have a negative effect on compliance and outcome if not addressed and left untreated.
Conclusions:
Because the comorbidity rate is high, screening for psychological symptoms is recommended for all children in all settings with enuresis and/or daytime urinary and/or fecal incontinence. Standardized, validated questionnaires are recommended. In addition to clinical observation and history, a short screening questionnaire can be used as a first step. If problem behaviors are present a longer broadband questionnaire is recommended. If problem items in the clinical range are noted, a full child psychiatric or psychological assessment is recommended.
References
- 1 : The standardization of terminology of lower urinary tract function in children and adolescents: report from the Standardisation Committee of the International Children's Continence Society. J Urol2006; 176: 314. Link, Google Scholar
- 2 : Management of Disorders of Bladder and Bowel Control in Childhood. London: MacKeith Press2006. Google Scholar
- 3 : Multiaxial Classification of Child and Adolescent Psychiatric Disorders: The ICD-10 Classification of Mental and Behavioural Disorders in Children and Adolescents. Cambridge: Cambridge University Press2008. Google Scholar
- 4 American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Text Revision (DSM-IV-TR). Washington, DC 2000. Google Scholar
- 5 : A 6 year follow-up of childhood enuresis: prevalence in adolescence and consequences for mental health. J Paediatr Child Health1990; 26: 75. Google Scholar
- 6 : Behavioural problems and attention-deficit hyperactivity disorder in children with enuresis: a literature review. Eur J Pediatr2005; 164: 665. Google Scholar
- 7 : Clinical behavioral problems in day- and night-wetting children. Pediatr Nephrol1999; 13: 662. Google Scholar
- 8 : Behavioral comorbidity differs in subtypes of enuresis and urinary incontinence. J Urol2008; 179: 295. Link, Google Scholar
- 9 : Do children with primary nocturnal enuresis have clinically significant behavior problems?. Arch Pediatr Adolesc Med1998; 152: 537. Google Scholar
- 10 : Life changes and protective capacities in enuretic and non-enuretic children. J Child Psychol Psychiatry1990; 31: 763. Google Scholar
- 11 : Alspac Study Team: Exploring the differences between mono- and polysymptomatic nocturnal enuresis. Scand J Urol Nephrol2006; 40: 313. Google Scholar
- 12 : An assessment of internalizing problems in children with enuresis. J Urol2004; 171: 2580. Link, Google Scholar
- 13 von Gontard A, Moritz AM, Thome-Granz S et al: Association of attention deficit and elimination disorders at school entry – an epidemiological study. Unpublished data, 2010. Google Scholar
- 14 : The prevalence of ADHD in children with enuresis: comparison between a tertiary and non-tertiary care sample. Acta Paediatr2006; 95: 347. Google Scholar
- 15 : Attention-deficit/hyperactivity disorder (ADHD) as a risk factor for persistent nocturnal enuresis in children: a two-year follow-up study. Acta Paediatr2005; 94: 1619. Google Scholar
- 16 : The prevalence of attention deficit-hyperactivity disorder in children with nonmonosymptomatic nocturnal enuresis: a 4-year followup study. J Urol2007; 178: 2616. Link, Google Scholar
- 17 : Management of urinary incontinence and nocturnal enuresis in attention-deficit hyperactivity disorder. J Urol2003; 170: 1347. Link, Google Scholar
- 18 : Psychological problems in children with daytime wetting. Pediatrics2006; 118: 1985. Google Scholar
- 19 : Early childhood risk factors associated with daytime wetting and soiling in school-age children. J Pediatr Psychol2008; 33: 739. Google Scholar
- 20 : Clinical differences in daytime wetting subtypes: urge incontinence and postponed voiding. J Urol2009; 182: 1967. Link, Google Scholar
- 21 : Psychological differences between children with and without soiling problems. Pediatrics2006; 117: 1575. Google Scholar
- 22 : Is encopresis always the result of constipation?. Arch Dis Child1994; 71: 186. Google Scholar
- 23 : Colonic transit times and behaviour profiles in children with defecation disorders. Arch Dis Child2004; 89: 13. Google Scholar
- 24 : Randomised trial of laxatives in treatment of childhood encopresis. Lancet1991; 338: 523. Google Scholar
- 25 : An exploration of children's views of bed-wetting at 9 years. Child Care Health Dev2008; 34: 65. Google Scholar
- 26 : Health related quality of life of a tertiary referral center population with urinary incontinence using the DCGM-10 questionnaire. J Urol2009; 182: 2000. Link, Google Scholar
- 27 : Health-related quality of life in young adults with symptoms of constipation continuing from childhood into adulthood. Health Qual Life Outcomes2009; 7: 20. Google Scholar
- 28 : Nocturnal enuresis: a survey of parental coping strategies at 7 1/2 years. Child Care Health Dev2005; 31: 659. Google Scholar
- 29 : Manual for the Child Behavior Checklist/4–18 and 1991 profile. Burlington: University of Vermont1991. Google Scholar
- 30 : Early detection of psychological problems in a population of children with enuresis: construction and validation of the short screening instrument for psychological problems in enuresis. J Urol2007; 178: 2611. Link, Google Scholar
