Psychological and Psychiatric Issues in Enuresis and Urinary Incontinence—A Revised and Updated Document of the International Children's Continence Society (ICCS)

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.