![]() Organic causes have to be ruled out as further criteria. If children wet during both daytime and nighttime, they will receive two appropriate diagnoses. Non-organic (functional) daytime urinary incontinence is defined by intermittent wetting during awake periods. Nocturnal enuresis (or simply enuresis) refers to any intermittent wetting during sleep, which includes Two main groups can be distinguished for intermittent incontinence: nocturnal enuresis, and functional daytime urinary incontinence ( table 1). The ICCS distinguishes between frequent, intermittent forms of wetting, which are predominantly non-organic, and the rare, continuous forms of incontinence, which predominantly have organic causes (e.g., structural, neurogenic, infectious, or other pediatric illnesses) ( 8, 12). For further details, please refer to current English and German textbooks ( 9– 11).Ĭlassification: Enuresis and urinary incontinence The purpose of this article is to provide a current, practical review of the workup and treatment of these common disorders. As a result, the new international classification system of the International Children’s Continence Society (ICCS) ( 8) has become particularly important, as it takes into account the current state of research. The classification systems of ICD-10 ( 5) and DSM-5 ( 6) are not up-to-date and do not allow the different subtypes of elimination disorder to be adequately differentiated ( 7). About 10% of seven-year-olds wet at night, and up to 6% during the day ( 4). Two major groups can be distinguished: nocturnal enuresis and daytime urinary incontinence. ![]() The prerequisite for an effective therapy is a precise, specific diagnosis of the respective elimination disorder. Therefore, early and effective treatment is important. Despite a spontaneous recovery rate of 15% per year, they can continue into adolescence ( 2, 3). In intractable cases, training techniques have been found useful.Įlimination disorders are common, well treatable childhood disorders, associated with high levels of distress and increased rates of psychiatric and other comorbid disorders ( 1). Pharmacotherapy, e.g., with desmopressin, can be a helpful adjunctive treatment. For enuresis, the treatment of first choice is alarm therapy, with which 50–70% of the affected children become dry. Elements of specific urotherapy are provided only if indicated. This conservative, symptom-oriented approach consists of educating the patient and his or her parents to promote behavior changes with respect to drinking and micturition. With standard urotherapy, 56% of patients with daytime urinary incontinence become dry within a year. 20–50% of children with elimination disorders have a comorbid mental disorder that also needs to be treated. If the child is suffering from multiple types of elimination disorder at once, then fecal incontinence or constipation is treated first, daytime urinary incontinence next, and enuresis last. ![]() Diagnostic assessment focuses on the clinical picture, is non-invasive, and can be carried out in most health care settings.
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