title: Psychological and psychiatric issues in urinary and fecal incontinence.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany. alexander.von.gontard@uks.eu
authors.forename: Alexander
authors.initials: A
authors.lastname: von Gontard
authors.forename: Dieter
authors.initials: D
authors.lastname: Baeyens
authors.forename: Eline
authors.initials: E
authors.lastname: Van Hoecke
authors.forename: William J
authors.initials: WJ
authors.lastname: Warzak
authors.forename: Christian
authors.initials: C
authors.lastname: Bachmann
mesh_terms: D002648:Child; D005242:Fecal Incontinence / Q000150:complications* / Q000523:psychology*; D006801:Humans; D001523:Mental Disorders / Q000150:complications*; D053206:Nocturnal Enuresis / Q000150:complications* / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D017410:Practice Guidelines as Topic; D014549:Urinary Incontinence / Q000150:complications* / Q000523:psychology*