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Published on: August 14, 2019
The Diagnosis and Treatment of Enuresis and Functional Daytime Urinary Incontinence
Alexander von Gontard1, Eberhard Kuwertz-Bröking
1Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Saarland University Medical Center, Homburg, Germany Formerly: Department of Pediatrics, Pediatric Nephrology, University Hospital Münster, Münster, Germany.
Insights
Childhood elimination disorders, including nocturnal enuresis and daytime urinary incontinence, are common and treatable. Targeted diagnosis and treatment, starting from age five, lead to effective outcomes and improved quality of life.
Area of Science:
- Pediatrics
- Urology
- Child Psychology
Background:
- Elimination disorders affect approximately 10% of 7-year-olds (nocturnal enuresis) and 6% (daytime urinary incontinence).
- Two primary types exist: nocturnal enuresis and functional daytime urinary incontinence, each with various subtypes.
- Effective treatment necessitates precise subtype identification.
Purpose of the Study:
- To review current diagnostic and treatment strategies for childhood elimination disorders.
- To emphasize the importance of targeted evaluation and subtype-specific interventions.
- To provide guidance on managing comorbid conditions and persistent symptoms.
Main Methods:
- Review of current literature, including the German S2k-AWMF guideline and International Children's Continence Society (ICCS) recommendations.
- Focus on non-invasive diagnostic assessment based on clinical presentation.
- Prioritization of treatment for comorbid conditions (constipation/fecal incontinence) before urinary issues.
Main Results:
- Standard urotherapy achieves dryness in 56% of daytime urinary incontinence cases within a year.
- Alarm therapy is the primary treatment for enuresis, with 50-70% success rates.
- Pharmacotherapy (e.g., desmopressin) and training techniques offer adjunctive benefits for persistent cases.
Conclusions:
- Childhood elimination disorders are effectively treatable with targeted diagnostics and specific interventions.
- Early evaluation and treatment (from age five) are crucial due to emotional distress and potential long-term persistence.
- Addressing comorbid mental health issues is vital for comprehensive management.
Background:
Elimination disorders in childhood are common and treatable. Approximately 10% of 7-year-olds wet the bed at night, and 6% are affected by incontinence during the daytime. Two main types of disturbance are distinguished: nocturnal enuresis and functional (i.e., non-organic) daytime urinary incontinence. Each type contains a wide variety of subtypes. Effective treatment requires precise identification of the subtype of elimination disorder.
Methods:
This review is based on a selection of current publications, including principally the German S2k-AWMF guideline and the recommendations of the International Children's Continence Society (ICCS).
Results:
Diagnostic assessment focuses on the clinical picture, is non-invasive, and can be carried out in most health care settings. If the child is suffering from multiple types of elimination disorder at once, then fecal incontinence or constipation is treated first, daytime urinary incontinence next, and enuresis last. 20-50% of children with elimination disorders have a comorbid mental disorder that also needs to be treated. With standard urotherapy, 56% of patients with daytime urinary incontinence become dry within a year. This conservative, symptom-oriented approach consists of educating the patient and his or her parents to promote behavior changes with respect to drinking and micturition. Elements of specific urotherapy are provided only if indicated. For enuresis, the treatment of first choice is alarm therapy, with which 50-70% of the affected children become dry. Pharmacotherapy, e.g., with desmopressin, can be a helpful adjunctive treatment. In intractable cases, training techniques have been found useful.
Conclusion:
Childhood elimination disorders can be treated effectively after targeted diagnostic evaluation and the establishment of specific indications for treatment. In view of the emotional distress these disorders cause, the associated physical and mental disturbances, and their potential persistence into adolescence, they should be evaluated and treated in affected children from the age of five years onward.
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