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Published on: August 28, 2020
Behavioral comorbidity differs in subtypes of enuresis and urinary incontinence
Susanne Zink1, Christine M Freitag, Alexander von Gontard
1Department of Child and Adolescent Psychiatry, Saarland University Hospital, Saarbrucken, Saarland, Germany. Susanne.zink@uniklinikum-saarland.de
Insights
Children with different types of enuresis and incontinence show varying behavioral issues and psychiatric conditions. Voiding postponement has the highest comorbidity, while monosymptomatic nocturnal enuresis has the lowest.
Area of Science:
- Pediatric Urology
- Child Psychiatry
- Behavioral Science
Background:
- Nocturnal enuresis and daytime incontinence are common in children.
- Behavioral and somatic factors can influence these conditions.
- Understanding comorbidity is crucial for effective management.
Purpose of the Study:
- To investigate the association of comorbid behavioral and somatic factors in children with various forms of enuresis and daytime incontinence.
- To compare behavioral profiles across different subtypes of urinary incontinence.
Main Methods:
- Prospective study of 166 children (5.1-16.4 years) referred to a tertiary center.
- Evaluations included history, physical exam, voiding protocols, sonography, and uroflow.
- Parents completed the Child Behavior Checklist; ICD-10 diagnoses were established.
Main Results:
- Externalizing disorders were more prevalent than internalizing disorders.
- Children with non-monosymptomatic nocturnal enuresis, urge incontinence, and voiding postponement showed higher rates of psychiatric diagnoses and encopresis compared to those with monosymptomatic nocturnal enuresis.
- Significant differences in behavioral scores, psychiatric diagnoses, and encopresis were observed among enuresis/incontinence subtypes.
Conclusions:
- Distinct subtypes of enuresis and urinary incontinence are associated with specific behavioral problems and psychiatric comorbidities.
- Voiding postponement exhibited the highest psychiatric comorbidity, whereas monosymptomatic nocturnal enuresis showed the lowest.
- Screening for comorbid psychiatric disorders in children with enuresis and urinary incontinence is recommended.
Purpose:
The aim of this prospective study is to describe the association of comorbid behavioral and somatic factors in children with different forms of nocturnal enuresis and daytime incontinence referred to a tertiary center.
Materials And Methods:
A total of 166 consecutive children 5.1 to 16.4 years old were referred for detailed assessment between January 2004 and July 2006. Evaluation included a detailed history, pediatric examination, 24 to 48-hour voiding protocols, sonography and uroflow. Parents filled out the Child Behavior Checklist, a standardized parental questionnaire consisting of 113 problem items. ICD-10 diagnoses were given based on standardized mental state examination and mutual consensus conferences.
Results:
In the full sample externalizing disorders were more than twice as common as internalizing disorders. Differences were found between children with nocturnal enuresis and daytime incontinence regarding parent reported externalizing behavior scores as well as rates of "at least 1 ICD-10 psychiatric diagnosis" and comorbid encopresis. Children with monosymptomatic nocturnal enuresis showed fewer internalizing disorders and lower rates of "at least 1 ICD-10 psychiatric diagnosis" and comorbid encopresis compared to those with nonmonosymptomatic nocturnal enuresis, urge incontinence and voiding postponement. The results of sonography and uroflow measures also differed between groups.
Conclusions:
Different subtypes of enuresis and urinary incontinence demonstrate differences in behavioral problems and psychiatric comorbidity. The highest rates of psychiatric comorbidity were found in the group of children with voiding postponement and the lowest were in children with monosymptomatic nocturnal enuresis. We recommend screening for comorbid psychiatric disorders in children with enuresis and urinary incontinence. Further investigations in a larger group of children are necessary.
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