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Psychological and Psychiatric Issues in Enuresis and Urinary Incontinence-A Revised and Updated Document of the
A von Gontard1, C Joinson2, U Barroso3
1Governor Kremers Center, Department of Urology, Maastricht University Medical Center, Maastricht, The Netherlands.
Insights
Children with nocturnal enuresis (NE) and daytime urinary incontinence (DUI) have a high rate of psychological and psychiatric disorders. Early screening and assessment are recommended to improve treatment outcomes.
Area of Science:
- Pediatric Psychology
- Child Psychiatry
- Urology
Background:
- Nocturnal enuresis (NE) and daytime urinary incontinence (DUI) affect a significant number of children.
- Psychological and psychiatric comorbidities are frequently observed in children with NE and DUI.
- These comorbidities can negatively impact treatment adherence and overall outcomes.
Purpose of the Study:
- To provide an updated overview of the psychological and psychiatric aspects of NE and DUI.
- To review clinical behavioral disorders and subclinical psychological symptoms associated with these conditions.
- To outline recommendations for screening, assessment, counseling, and treatment.
Main Methods:
- A review of relevant publications on psychological and psychiatric aspects of NE and DUI.
- Consensus-based recommendations developed and refined through multiple rounds.
- Circulation of recommendations among International Children's Continence Society (ICCS) board members.
Main Results:
- Children with NE/DUI exhibit increased rates of comorbid psychiatric disorders compared to continent children.
- 20-30% of children with NE and 20-40% with DUI meet criteria for clinically relevant psychiatric disorders.
- Common comorbidities include externalizing, internalizing, and neurodevelopmental disorders, impacting self-esteem, quality of life, and stress.
Conclusions:
- Screening for psychological symptoms is recommended for all children with NE or DUI due to high comorbidity rates.
- Validated behavioral questionnaires are recommended alongside clinical observation and history taking.
- A full child psychiatric or psychological assessment is advised if problem items are identified in the clinical range.
Purpose:
The aim is to provide an updated and revised overview of psychological and psychiatric aspects of nocturnal enuresis (NE) and daytime urinary incontinence (DUI). 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.
Methods:
Relevant publications on psychological and psychiatric aspects are reviewed. The recommendations passed several rounds of consensus finding and were circulated among ICCS board members.
Results:
In addition to subclinical effects on self-esteem, quality of life and stress, the rate of comorbid psychiatric disorders is increased compared to continent children. 20%-30% of children with NE and 20%-40% with DUI fulfill the criteria for clinically relevant psychiatric disorders. These concomitant psychological disturbances include externalizing, internalizing and neurodevelopmental disorders. They require assessment and counseling, in severe cases treatment. They have a negative effect on compliance and outcome if not addressed and left untreated. The paper provides an overview of the most important and common disorders encountered in young patients with NE/DUI.
Recommendations:
Because the comorbidity rate is high, screening for psychological symptoms is recommended for all children with NE or DUI in all settings. In addition to clinical observation, exploration and history taking, standardized, validated broadband behavioral questionnaires are recommended. If problem items in the clinical range are present, a full child psychiatric or psychological assessment is recommended.
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