Functional daytime incontinence: non-pharmacological treatment.
In children with 'functional incontinence', defined as any form of (daytime) wetting caused by non-neuropathic bladder/sphincter dysfunction, most signs and symptoms are rooted in habitual non-physiological responses to signals from bladder and urethra. These responses develop at toddler age, when children learn how to remain dry. Once they have become a habit, incomplete bladder emptying and recurrent urinary tract infections come into play, reiterating the non-physiological responses into fixed patterns of bladder/sphincter dysfunction with functional incontinence as the leading symptom. Non-pharmacological treatment of functional incontinence implies relearning and training the normal responses to signals from bladder and urethra: a cognitive process, with perception of the signals reinforced by biofeedback. This type of treatment is best combined with long-term chemoprophylaxis. Severe cases will benefit from anticholinergic drugs, as adjuvants to the training programme. Urodynamics play a crucial role in documenting the specific patterns of incontinence and in providing biofeedback. For a successful programme, psychological screening of the children is indispensable.
van Gool
J D
JD
Division of Children's Surgical Associates Ltd., Philadelphia, PA.
Vijverberg
M A
MA
Messer
A P
AP
Elzinga-Plomp
A
A
de Jong
T P
TP
D000293:Adolescent; D001676:Biofeedback, Psychology; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D015928:Cognitive Behavioral Therapy; D005500:Follow-Up Studies; D006801:Humans; D012008:Recurrence; D013997:Time Factors; D014549:Urinary Incontinence / Q000150:complications / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D014552:Urinary Tract Infections / Q000150:complications