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[Elimination disorders in childhood. How to make children dry and clean]

A von Gontard1

  • 1Klinik für Kinder- und jugendpsychiatrie und -psychotherapie, Klinikum der Universität zu Köln. alexander.vongontard@medizin.uni-koeln.de

MMW Fortschritte Der Medizin
|November 1, 2003
PubMed

Insights

Evacuation disorders like enuresis nocturna and encopresis stem from genetic and environmental factors. Treatment varies, including alarm devices, desmopressin, behavioral therapies, and addressing constipation.

Area of Science:

  • Pediatric Gastroenterology
  • Urology
  • Developmental Pediatrics

Background:

  • Evacuation disorders encompass enuresis nocturna and encopresis, influenced by complex genetic and environmental interactions.
  • Enuresis nocturna is linked to genetic central nervous system (CNS) developmental issues, with or without diurnal bladder dysfunction.
  • Encopresis can arise from acute constipation or psychological factors, necessitating targeted interventions.

Purpose of the Study:

  • To delineate the distinct causes and therapeutic strategies for enuresis nocturna and encopresis.
  • To differentiate treatment approaches based on the presence or absence of diurnal bladder dysfunction in enuresis.
  • To outline management options for functional continence disorders associated with diurnal enuresis.

Main Methods:

  • Review of genetic and environmental factors contributing to evacuation disorders.
  • Analysis of first-line and second-choice treatments for enuresis nocturna (alarm devices, desmopressin).
  • Evaluation of cognitive-behavioral measures, biofeedback, and symptom-oriented treatments for diurnal enuresis and encopresis.

Main Results:

  • Enuresis nocturna treatment involves alarm devices primarily, with desmopressin as a secondary option.
  • Diurnal enuresis management focuses on cognitive-behavioral therapies and biofeedback for conditions like urge incontinence.
  • Encopresis treatment is symptom-based, incorporating behavioral and dietary changes, and addressing constipation with laxatives or enemas.

Conclusions:

  • Effective management of evacuation disorders requires understanding their diverse etiologies, from genetic CNS issues to functional and psychological factors.
  • Tailored therapeutic strategies, including behavioral interventions and pharmacological options, are crucial for improving continence in children.
  • Integrated approaches addressing both the underlying causes and symptoms are essential for successful treatment outcomes in enuresis and encopresis.

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