Psychological and psychiatric issues in urinary and fecal incontinence

Purpose: We provide an overview of the psychological and psychiatric aspects of nocturnal enuresis, urinary and fecal incontinence. 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. Materials and Methods: Relevant publications on psychological and psychiatric aspects are reviewed. The recommendations passed several rounds of consensus finding, and were circulated among International Children's Continence Society members and external experts. Results: In addition to subclinical effects on self-esteem, quality of life and distress, the rate of comorbid clinical behavioral disorders is increased. In fact, 20% to 30% of children with nocturnal enuresis, 20% to 40% with daytime urinary incontinence and 30% to 50% with fecal incontinence fulfill the criteria for ICD-10 or Diagnostic and Statistical Manual of Mental Disorders IV psychiatric disorders. These concomitant disturbances require assessment and counseling, and in severe cases treatment. They have a negative effect on compliance and outcome if not addressed and left untreated. Conclusions: Because the comorbidity rate is high, screening for psychological symptoms is recommended for all children in all settings with enuresis and/or daytime urinary and/or fecal incontinence. Standardized, validated questionnaires are recommended. In addition to clinical observation and history, a short screening questionnaire can be used as a first step. If problem behaviors are present a longer broadband questionnaire is recommended. If problem items in the clinical range are noted, a full child psychiatric or psychological assessment is recommended.