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Zusammenfassung. Hintergrund: Obstipation und Stuhlinkontinenz gehören zu den häufigsten Störungen des Kindesalters, die mit einer hohen Beeinträchtigung und komorbiden psychischen Störungen einhergehen können. Nach der neuen Rome-IV-Klassifikation wird zwischen einer funktionellen Obstipation und einer nicht-retentiven Stuhlinkontinenz unterschieden. Das Ziel dieser interdisziplinären Leitlinie ist es, den aktuellen Stand zur Diagnostik und Therapie dieser Störungen aus somatischer und psychiatrischer Sicht zusammenzufassen und praxisorientierte Empfehlungen zu formulieren. Methoden: Die Leitliniengruppe setzte sich aus 11 Fachgesellschaften und einer Elterngruppe zusammen. Die Leitlinie wurde auf der Basis aktueller Literaturrecherchen in mehreren Onlineabstimmungen und Konsensuskonferenzen nach den Regeln der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V. (AWMF) verabschiedet. Ergebnisse: Die funktionelle Obstipation ist sehr viel häufiger als die nicht-retentive Stuhlinkontinenz. Die Obstipation erfordert ein sorgfältiges medizinisches Vorgehen, um somatische Ursachen auszuschließen, gerade bei jungen Kindern. Dazu dienen somatische Warnzeichen, die besonders berücksichtigt werden müssen. Die meisten Fälle der Obstipation sind funktionell (ca. 95 %). Beratung, Toilettentraining, Desimpaktion und langfristige orale Laxanzien, kombiniert mit verhaltenstherapeutischen Maßnahmen, sind am wirkungsvollsten. Die Diagnostik und Therapie der nicht-retentiven Stuhlinkontinenz ist ähnlich. Die Rate von somatischen Ursachen ist niedriger. Laxanzien können allerdings die Symptomatik verschlechtern und sollten vermieden werden. Komorbide psychische Störungen sind häufig (ca. 30–50 % der Fälle). Sie sollen erfasst und zusätzlich leitliniengerecht behandelt werden. Schlussfolgerungen: Im Konsensusverfahren konnten mit hoher Zustimmung wichtige Empfehlungen verabschiedet werden. Eine interdisziplinäre Zusammenarbeit ist von hoher Bedeutung, da somatische Faktoren und komorbide psychische Störungen und Symptome berücksichtigt werden müssen. Forschungsbedarf besteht vor allem bei der nicht-retentiven Stuhlinkontinenz.

The aim was to examine associations of specific anxiety disorders, depressive symptoms, and incontinence in a representative, population-based sample of preschool children.All preschool children of a defined geographical area examined before school-entry were included. Parents completed a questionnaire including the Preschool Feelings Checklist (PFC), eight questions referring to nocturnal enuresis (NE), daytime urinary incontinence (DUI), fecal incontinence (FI) and constipation, and 30 items regarding Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) diagnostic criteria of separation anxiety disorder (SAD), social phobia (SOC), specific phobia (PHOB), and generalized anxiety disorder (GAD). Data of 1206 children (mean age = 5.7 years; 53.5% boys) are presented.34.6% of incontinent children had an anxiety disorder based on DSM-5 criteria and 13.3% had clinically relevant depressive symptoms (measured by the PFC). Rates of incontinence overall were 14.1% (11.9% NE, 3.1% DUI, and 1.8% FI) and 6.3% for constipation. Rates of SOC and PHOB were increased in NE (20.8% and 25.4%), DUI (39.3% and 34.5%) and FI (35.3% and 50.0%) compared to continent children (13.5% and 17.2%). Children with constipation had higher rates of SOC, PHOB, and GAD than those without. Compared to continent children (9.7%), depressive symptoms were more frequent in children with NE (26.8%), DUI (50.0%), and FI (61.9%).Anxiety disorders and depressive symptoms are common in children with incontinence. The most specific DSM-5 disorders associated with incontinence are SOC and PHOB, which can be incapacitating and may require treatment. Due to the high rates of anxiety disorders, it is important to screen all children with incontinence, for example, with specific questionnaires.

BackgroundAdolescents with continence problems experience a unique range of threats to their psychological wellbeing including perceived stigma, social isolation, and poor self-image. Despite this, the long-term mental health sequelae of adolescent continence problems are unknown.MethodsWe used data from the Avon Longitudinal Study of Parents and Children (n=7,332: 3,639 males, 3,693 females) to examine prospective relationships between self-reported incontinence/lower urinary tract symptoms (LUTS) at 14 years (daytime wetting, bedwetting, soiling, urgency, frequent urination, low voided volume, voiding postponement, and nocturia) and common mental health problems at 18 years (any common mental disorder, depression, anxiety, self-harm, and disordered eating). We estimated multivariable regression models adjusted for sex, socioeconomic position, developmental level, IQ, stressful life events, maternal psychopathology, body mass index, and earlier emotional/behavioural problems.FindingsDaytime wetting and voiding postponement showed the greatest number of associations with mental health problems. All incontinence subtypes/LUTS were associated with increased odds of generalised anxiety disorder symptoms [e.g., odds ratio for daytime wetting= 3.01, 95% confidence interval (1.78, 5.09), pInterpretationIncontinence/LUTS at age 14 are associated with increased vulnerability to mental health problems in late adolescence. Treatment of incontinence/LUTS should be integrated with psychological support to mitigate long-term sequelae.

Emotional/behaviour problems and exposure to stressful life events are thought to contribute to new onset of urinary incontinence (UI) amongst children who have attained bladder control. However, very few prospective studies have examined these associations. We assessed whether mental health problems and stressful life events were associated with subsequent new onset in UI using multivariable logistic regression in a prospective UK cohort (n = 6408). Mothers provided information on their child’s symptoms of common mental disorders (Development and Wellbeing Assessment, 7 years), stressful life events (7–8 years) and wetting (day and night, 9 years). There was strong evidence that separation anxiety symptoms were associated with new-onset UI in the fully adjusted model (OR (95% CI) = 2.08 (1.39, 3.13), p p = 0.065), such that females experiencing more stressful life events were at higher risk of new-onset UI (fully adjusted model OR (95% CI) = 1.66 (1.05, 2.61), p = 0.029), but there was no association in males (fully adjusted model OR (95% CI) = 0.87 (0.52, 1.47), p = 0.608). These results suggest that separation anxiety and stressful life events in girls may lead to an increase in UI.

Objectives Standard urotherapy (SU) is regularly used as a first-line intervention for children with incontinence. It is suggested that SU is also effective for children with neurodevelopment disabilities (NDs) when altered to the specific needs of these children. The aim of the review was to answer the following research questions: (a) what was the effectiveness of SU interventions in children with ND?, (b) which procedures and protocols were utilized during SU?, (c) what was the role of parents during SU?, and (d) what was the current evidence base regarding SU and children with NDs? Methods Four electronic databases (i.e., Embase, PsychInfo, PubMed, Web of Science) were searched in accordance with the JBI methodology for mixed methods systematic reviews (MMRS) in the Joanna Briggs Institute (JBI) manual for Evidence Synthesis. The Mixed Method Appraisal Tool (MMAT) from JBI was utilized to determine the methodological quality of the studies. Results The search resulted in the inclusion of five articles related to SU in children with ND, indicating that research relating to SU and NDs is scarce. Results of the review indicate that SU resulted in a complete or partial positive response in 30% of the children with NDs (N = 114) based on the criteria listed by the International Children’s Continence Society (ICCS). When using criteria by the authors of the included articles, the results indicate that 59% of the children achieved full continence. Most importantly, the evidence suggests that most children showed improved symptoms (e.g., reduction in urinary/fecal accidents, schedule-dependent continence) even if full continence was not obtained. Conclusions The review indicated that SU could be beneficial as a first-line treatment for children with NDs. Individualizing treatment to the needs of the child, parental involvement, follow-up appointments, and adding adjuncts when SU alone is not effective seem to be beneficial for this specific population. However, research relating to this topic is scarce and therefore more research needs to be completed regarding the role of parents and effective guidelines specific to different NDs. Implications for future research are discussed.

Zusammenfassung. Ausscheidungsstörungen sind häufige Störungen des Kindesalters. Es können drei übergeordnete Gruppen unterschieden werden: die Enuresis nocturna, das Einnässen tagsüber und die Enkopresis oder Stuhlinkontinenz. Inzwischen sind viele Subgruppen identifiziert, die sich exakt diagnostizieren lassen. Das Ziel dieser Übersicht ist es, die Klassifikationsvorschläge der ICD-11 kritisch darzustellen. Die Definitionen der Enuresis nach ICD-11 werden mit den Störungsbildern der Enuresis nocturna und der funktionellen Harninkontinenz tags nach ICCS verglichen. Die Enkopresis nach ICD-11 wird den Rome-IV-Definitionen der funktionellen Obstipation und der nicht-retentiven Stuhlinkontinenz gegenübergestellt. Es wird dabei deutlich, dass die ICD-11 nicht dem aktuellen Forschungsstand entspricht, dass sie für die klinische Praxis keine therapieleitenden Diagnosen liefert und dass sie für die Forschung nicht genau genug ist. Deshalb sind die Klassifikationssysteme der ICCS und der Rome-IV in Klinik und Forschung vorzuziehen.

Emotional/behaviour problems and exposure to stressful life events are thought to contribute to relapses in urinary incontinence (UI) amongst children who have attained bladder control. However, very few prospective studies have examined these associations. We assessed whether mental health problems and stressful life events were associated with subsequent relapse in UI using multivariable logistic regression in a prospective UK cohort (n=6,408). Mothers provided information on their child’s symptoms of common mental disorders (Development and Wellbeing Assessment, 7 years), stressful life events (7-8 years) and wetting (day and night, 9 years). There was strong evidence that separation anxiety symptoms were associated with UI relapse in the fully adjusted model (OR (95% CI) = 2.08 (1.39, 3.13), p

Aims Children with nocturnal enuresis (NE), daytime urinary incontinence (DUI), and fecal incontinence (FI) are at risk for behavioral problems, overweight, and obesity. The aim of this study was to analyze the specific behavioral and weight comorbidity in subtypes of incontinence. Methods A total of 1638 consecutive patients presented to a tertiary incontinence clinic from 2012 to 2018 was examined prospectively according to ICCS criteria. Behavioral symptoms were measured with the Child Behavior Checklist (CBCL). Psychiatric disorders were diagnosed according to ICD-10 criteria. Weight categories were calculated according to WHO recommendations. Results The mean age was 7.8 years, 67% of patients were male. Fifty-seven percent had NE (n = 934), 33% DUI (n = 547), and 40% FI (n = 656). Boys had significantly higher rates of NE and FI than girls. Of all children, 39.2% (n = 539) had a clinically relevant CBCL total score. A total of 28.3% (n = 463) had an ICD-10 psychiatric diagnosis, mainly ODD and ADHD, and 28.6% (n = 463) were overweight or obese. Boys were more often affected by behavioral symptoms, psychiatric disorders, and overweight/obesity. Children with NE had the highest rate of overweight/obesity. Except for primary nonmonosymptomatic NE, subtypes of incontinence did not differ regarding behavioral symptoms and weight categories. However, overweight/obesity was significantly associated with behavioral and psychiatric parameters. Conclusions Behavioral symptoms and psychiatric disorders, as well as overweight/obesity are important risk factors associated with incontinence, but the interaction between these factors is complex. In clinical settings, all children with incontinence should be screened with behavioral questionnaires. Also, weight should be measured, and overweight/obesity should be addressed.

Psychische Storungen sind bei jungen Kindern haufig, konnen aber erkannt und wirksam behandelt werden. Dazu ist eine exakte Diagnose erforderlich. Das Klassifikationssystem DC: 0–5 wurde speziell fur das Alter bis zu funf Jahren entwickelt und ermoglicht altersspezifische Diagnosen. Besonders wichtig ist die erste Achse, die mogliche psychische Storungen beschreibt und erfasst. Das Ziel dieser Ubersicht ist es, Mitarbeitern/ -innen im Bereich der Fruhforderung eine praxisorientierte Ubersicht uber die Vielfalt psychischer Storungen und ihrer Diagnose nach DC: 0–5 zu vermitteln. Die Erfassung psychischer Storungen hat eine hohe Relevanz fur die Planung von Beratung und Therapie.

Zusammenfassung. Ziel dieser Studie ist die Interrater-Reliabilität, Validität und Akzeptanz des Strukturierten Interviews für das Vorschulalter (SIVA: 0 – 6) zu ermitteln. Es wurden 117 Interviews mit Eltern durchgeführt. Die Akzeptanz wurde mit einem Fragebogen erfasst. Die Interrater-Reliabilität wurde durch zwei unabhängige Diagnostiker für die Klassifikationssysteme DC: 0 – 3R/DC: 0 – 5, ICD-10 und DSM-5 bestimmt. Mit prozentualer Übereinstimmung, Cohen’s Kappa und Yule’s Y wurde die Übereinstimmung der Diagnostiker berechnet. Die Validität des SIVA: 0 – 6 wurde mittels der Konstruktvalidität mit Fragebögen und der Kriteriumsvalidität überprüft. Das SIVA: 0 – 6 hat eine hohe Akzeptanz. Die Interraterreliabilität für externalisierende (κ > .82, > 91.9 %), internalisierende Diagnosen (κ > .72, 93.5 %) sowie den Ausschluss von Diagnosen (> 97 %) war gut bis sehr gut. Die Validität zeigte sich in der Unterscheidung von Kindern mit und ohne eine Diagnose sowie internalisierenden Störungen. Die Ergebnisse sprechen für eine gute Akzeptanz, Validität und Reliabilität des SIVA: 0 – 6 in Praxis und Forschung.

Zusammenfassung. Um psychische Störungen bei jungen Kindern zu erfassen, wurde das Klassifikationssystem DC: 0 – 5 entwickelt. Das Ziel dieser Studie war es, Diagnosen nach DC: 0 – 5 und ICD-10 zu vergleichen. Bei 176 konsekutiv vorgestellten Kindern (70,5 % Jungen) mit einem mittleren Alter von 3,96 Jahren wurden Diagnosen nach ICD-10 und DC: 0 – 5 vergeben. 78,4 % der Kinder hatten eine Diagnose nach ICD-10, 88,1 % der Kinder nach DC: 0 – 5. Die häufigste ICD-10 Diagnose war Störung des Sozialverhaltens mit oppositionellem Verhalten (ODD; 28,4 %), gefolgt von Schlafstörungen (21,0 %), ADHS (14,8 %) und Angststörungen (6,8 %). Die häufigsten DC: 0 – 5 Diagnosen waren ADHS (30,7 %) und die Dysregulierte Ärger- und Aggressionsstörung (31,3 %), gefolgt von Schlaf-‍, Angst-‍, Ess- und Traumafolgestörungen. Zusammengefasst ist die DC: 0 – 5 das spezifischste Klassifikationssystem zur Diagnose psychischer Störungen bei jungen Kindern. Es hat sich in Kombination mit der ICD-10 in der klinischen Praxis bewährt. Wünschenswert wäre die weitere Verwendung und Überprüfung der DC: 0 – 5 in klinischen Studien.

Zusammenfassung. Psychische Störungen sind bei jungen Kindern häufig und weisen eine entwicklungsbezogene Symptomatik auf. Die DC: 0 – 5 wurde als ein multiaxiales Klassifikationssystem psychischer Störungen für das Alter von 0 bis 5 Jahren entwickelt. Das Ziel dieser Übersicht ist es, den Aufbau und die Anwendung der DC: 0 – 5 darzustellen. Sie umfasst die fünf Achsen: klinische Störungen, Beziehungskontext, medizinische Diagnosen, psychosoziale Stressoren und Entwicklungskompetenzen. Die erste Achse ist die wichtigste und hat viele neue Störungsbilder definiert. Als neue Angststörung bezeichnet z. B. die Störung mit Inhibition gegenüber Neuem eine Furcht gegenüber neuen Stimuli. Ein Novum ist die Spezifische Beziehungsstörung der frühen Kindheit, die das Auftreten von einer kindlichen Symptomatik speziell in einer Beziehung definiert und eine akute Gefährdung des Kindes signalisiert. Die DC: 0 – 5 ist das derzeitig beste System zur Erfassung psychischer Störungen bei jungen Kindern. Eine weitere empirische Überprüfung und Validierung gerade der neuen Kategorien ist notwendig.

Aims Psychological morbidities play a major role in idiopathic lower urinary tract dysfunction (iLUTD). The aim of the Think Tank (TT) was to discuss the relevance of psychological morbidities in idiopathic LUTD over the life span, including overactive bladder (OAB) or dysfunctional voiding (DV) and methods of assessment. Methods The paper is based on a selective review of the literature and in-depth discussions, leading to research recommendations regarding the assessment of psychological morbidities in iLUTD on children and adults held during the TT of the International Consultation on Incontinence Research Society in 2019. Results Psychological comorbidities affect the health behaviors and treatment outcomes in patients with iLUTD. Both clinically relevant comorbid mental disorders, as well as subclinical psychological symptoms have a major impact and negatively influence incontinence treatment. Research is needed to elucidate mechanisms underlying iLUTD and psychological comorbidities. Clinical studies are needed to determine how perception generation and cognition impacts on the relationship of urinary perceptions, symptoms, and objective urodynamic function. Due to high psychological comorbidity rates, screening with validated, generic questionnaires for emotional and behavioral disorders in children with nocturnal enuresis, daytime urinary incontinence, and fecal incontinence is recommended. Brief screening is recommended for all adults with iLUTD, especially with OAB and DV, who are refractory to treatment. Conclusions Due to the high rate and relevance in clinical practice, screening for psychological comorbidities is recommended for all age groups. The research recommendations of this TT may be followed to improve the assessment of psychological morbidities in iLUTD.

BACKGROUND: According to a population-based study, approximately 6.8% of children and adolescents in Germany suffer from acute or chronic constipation. It can be of organic or functional origin and may be associated with comorbid disturbances, particularly fecal incontinence. METHODS: We selectively searched the PubMed and Google Scholar databases for articles with the keywords “constipation,” “children and adolescents,” and “incontinence“. Recommendations are based on the AWMF guideline on constipation and fecal incontinence and on international guidelines and reviews. RESULTS: More than 90% of cases of chronic constipation are of functional origin. Organic causes vary with age and call for targeted differential diagnosis. Invasive tests are only rarely necessary. Functional constipation may be associated with fecal and urinary incontinence, and the relative risk of urinary tract infections is 2.2 to 6.5. There may be associated psychological symptoms and mental disorders in 30–50% of cases. The cornerstone of treatment is patient and parent education, along with laxative medication and toilet training. Instructional programs have been found effective in otherwise refractory cases. CONCLUSION: The treatment of constipation in childhood should begin as soon as the differential diagnostic evaluation is completed. The education of parents, follow-up at close intervals, and drug treatment and behavioral therapy that are adapted to the symptoms can improve quality of life.

To assess the impact of parasacral transcutaneous electrical nerve stimulation (parasacral TENS) on quality of life (QoL) and psychological aspects in children treated for overactive bladder (OAB).This international, multicenter, prospective cohort study involved individuals of 6-16 years of age under TENS treatment for OAB. The study was conducted between June 2016 and December 2019 in four participating centers: two in Australia, one in Germany and one in Brazil. Patients with anatomical and/or neurological abnormalities of the urinary tract were excluded. Questionnaires were applied before and after parasacral TENS treatment: the Dysfunctional Voiding Symptom Score (DVSS), used in Brazil, or the International Consultation on Incontinence Questionnaire - Pediatric Lower Urinary Tract Symptoms (ICIQ-CLUTS), used in Germany and Australia, to analyze urinary symptoms; the Strengths and Difficulties Questionnaire (SDQ) to assess emotional and behavioral aspects; and the Pediatric Incontinence Questionnaire (PinQ) for bladder-specific Qol.Fifty-three patients (28 girls and 25 boys) with a mean age of 8.64 ± 2.63 years were included. Median DVSS was 11 (range 6-13.5) and 3 (range 0-7), (p 0.001), and median ICIQ-CLUTS was 12 (range 9-14) and 9 (range 5.7-12), (p 0.001), before and after treatment, respectively. Median PinQ score decreased from 47.8 (range 38.9-59.7) to 39 (range 29-53.15) following treatment (p = 0.04). Median total SDQ score before and after treatment was 17 (range 13.5-21) and 15 (range 12-21), respectively (p = 0.939).Parasacral TENS was associated with a significant improvement in urinary symptoms and QoL; however, there was no change in psychological symptoms, as measured using the SDQ.

The attitudes and practices of young Buddhists could very well be influenced by their respective personality types. This is the focus of the interesting book by Phra Nicholas Thanissaro, a long sta...

BackgroundMaternal anxiety increases the risk for incontinence in children. The aim was to analyze anxiety in children with incontinence and their parents before (t1) and after 6 months of incontinence treatment (t2).Methods40 children with incontinence and 40 controls completed the State-trait Anxiety Inventory for Children, their parents the Child Behavior Checklist (CBCL) and the State-trait Anxiety Inventory at baseline (t1) and 6 months later (follow-up, t2). Psychiatric disorders were assessed by a standardized parental diagnostic interview (Kinder-DIPS), IQ was tested by a one-dimensional test. All children were neurologically examined. Children with incontinence underwent a guideline-based treatment during the 6 months.ResultsAt baseline, child and parental state and trait anxiety scores, as well as all CBCL scores were significantly higher in the patient group compared to the control group. At t2, parental anxiety, CBCL scores, and child trait anxiety were significantly higher in patients versus controls, whereas child state anxiety decreased, and parental state anxiety increased from t1 to t2.ConclusionsIncontinence and anxiety are associated. While state anxiety decreases, trait anxiety can remain stable over time. Higher levels of anxiety can influence incontinence treatment and should be assessed in every patient.

ADHD often affects multiple generations in a family. Previous studies suggested that children with ADHD benefit less from therapy if parents are also affected, since ADHD symptoms interfere with treatment implementation. This two-group randomised controlled trial examined whether targeting maternal ADHD boosts the efficacy of parent–child training (PCT) for the child’s ADHD. Here, we report follow-up results 2 years from baseline. Mothers of 144 mother–child dyads (ADHD according to DSM-IV) were examined for eligibility (T1) and randomised to 12 weeks of intensive multimodal treatment comprising pharmacotherapy and DBT-based cognitive behavioural group psychotherapy (TG, n = 77) or clinical management comprising non-specific counselling (CG, n = 67) for Step 1 (concluded by T2). Subsequently, all dyads participated in 12 weekly PCT sessions for Step 2 (concluded by T3). In Step 3, participants received maintenance treatments for 6 months (concluded by T4). At 24 months after baseline (T5), we performed follow-up assessments. The primary endpoint was child ADHD/ODD score (observer blind rating). Outcomes at T5 were evaluated using ANCOVA. Assessments from 101 children and 95 mothers were available at T5. Adjusted means (m) of ADHD/ODD symptoms (range 0–26) in children did not differ between TG and CG (mean difference = 1.0; 95% CI 1.2–3.1). The maternal advantage of TG over CG on the CAARS-O:L ADHD index (range 0–36) disappeared at T5 (mean difference = 0.2; 95% CI − 2.3 to 2.6). Sensitivity analyses controlling for medication and significant predictors of follow-up participation showed unchanged outcomes. Within-group outcomes remained improved from baseline. At the 24-month follow-up, TG and CG converged. The superiority of intensive treatment regarding maternal symptoms disappeared. In general, cross-generational treatment seems to be effective in the long term. (BMBF grant 01GV0605; registration ISRCTN73911400).

AIMS: Mounting evidence from experimental animal and human studies suggests that cross-sensitization exists between different organs. Lower urinary tract (LUT) and bowel dysfunction commonly overlap, and the role of cross-sensitization between pelvic visceral organs is uncertain.METHODS: At the International Consultation on Incontinence Research Society (ICI-RS) meeting in 2018, a panel of clinicians participated in a discussion on bladder and bowel interactions in the context of pelvic organ cross-sensitization.RESULTS: Bladder and bowel problems commonly co-occur in adults and children across different disorders, and the mechanism responsible for overlapping dysfunction is uncertain in most instances. At a neuronal level, cross-sensitization occurs as a result of afferent signaling from the LUT and lower bowel through different central and peripheral mechanisms. Studies in animals and humans have demonstrated evidence for cross-organ sensitization following experimental inflammation or distension of the lower bowel, affecting the LUT. Nerve stimulation is an effective treatment for different functional LUT and bowel disorders, and whether this treatment may influence cross-organ sensitization remains uncertain. The role of physiologically dormant C-fibers, the bladder-gut-brain axis, and gut microbiome in cross-sensitization are speculative.CONCLUSION: Recommendations for research were made to explore the role of cross-organ sensitization in the pathogenesis of co-occurring LUT and bowel dysfunction in humans.

Aims To review studies on the comorbid psychological symptoms and disorders in patients with lower urinary tract disorders (LUTD) over the life-span, to analyse how they contribute toward the aetiology of LUTD and to discuss optimal service implementation. Materials and methods A review of relevant literature was conducted and presented during the ICI-RS meeting in 2018. Open questions and future directions were discussed. Results On the basis of current research, there is overwhelming evidence in all age groups that psychological comorbidities are more common in patients with LUTD. Vice versa, patients with psychiatric disorders have higher rates of LUTD. The types of LUTDs and psychiatric disorders are heterogeneous. Complex aetiological models best explain specific associations of comorbidity. Irrespective of aetiology, it is advisable to address both urological and psychological issues in patients of all age groups with LUTD. Conclusions Psychological symptoms and disorders play a decisive role in the development of LUTD in all age groups and need to be considered in the assessment and treatment of LUTD.

Aims Headaches in preschool children are associated with behavioral and gastrointestinal symptoms. As the co-occurrence with incontinence is not known in young children, the aim of the study was to examine associations of headache, psychological symptoms and nocturnal enuresis (NE), daytime urinary incontinence (DUI), and fecal incontinence (FI) in a population-based sample of preschool children. Methods All preschool children of a defined geographical area were examined at school-entry. Parents completed a 22-item questionnaire, including 14 headache, 4 incontinence, and 25 items of the Strength and Difficulties Questionnaire (SDQ). Five hundred eighty-five children (50.4% males) with a mean age of 5.8 years were included. Results In total, 27.2% of all children had headaches. 15.7% had secondary and 11.3% primary headaches. Five children had migraine and five tension-type headaches, while all others were unclassifiable. 9.4% of children had incontinence (7.7% NE; 2.4% DUI, 1.2% FI) and 4.0% constipation. The rates of incontinence did not differ between children with primary and those without headache for NE (12.9% vs 7.5%), DUI (3.1% vs 2.7%) or FI (3.0% vs 1.0%), but for constipation (12.1% vs 2.6%). Incontinent children had significantly more behavioral and externalizing symptoms, children with headache more internalizing problems. Primary headache was a significant predictor for internalizing, while constipation and FI were predictors for externalizing symptoms. Conclusions This population-based study showed that headache is associated with constipation, but not with incontinence in preschool children. Headache and incontinence are common risk factors for specific psychological symptoms and should be assessed in clinical practice.

Aims Neurodevelopmental disorders (NDs) are incapacitating disorders, which begin early in life, are mainly caused by genetic and neurobiological factors, and show a tendency to persist. They are associated with higher rates of incontinence in children and adolescents, including nocturnal enuresis, daytime urinary incontinence, fecal incontinence, and constipation. Without diagnosis and treatment, they will interfere with incontinence treatment leading to less favorable outcomes. The aim of this International Children's Continence Society (ICCS) document is to provide an overview of the three most important NDs, that is, attention-deficit/hyperactivity disorder, autism spectrum disorder (ASD), and intellectual disability (ID). Methods This consensus paper was commissioned by the ICCS. A selective, nonsystematic review was performed. Guidelines, reviews, and selected studies were included. The recommendations are consensus-based. Results ADHD is the most common ND with special relevance in clinical practice. ASD and ID are less common, but more severe disorders than ADHD. Basic principles of the assessment and treatment of NDs are provided. Incontinence is common among patients with NDs. Specific modifications and practical approaches in the treatment of incontinence in children with NDs are outlined. Conclusions Incontinence in children and adolescents with NDs is common. Effective treatment of incontinence should be adapted and modified to the specific needs of patients with NDs. A multiprofessional approach is recommended.

Abstract. Objective: Incontinence and functional gastrointestinal disorders are common in young children and are associated with higher rates of psychological symptoms and mental disorders. This article focuses on the mutual association between incontinence and related toilet refusal syndrome, parental stress, and children’s psychopathology especially in young children. Methods: Children’s psychological symptoms, mental disorders, and parental stress levels were assessed in 38 parent-child dyads involving children with incontinence and 42 dyads of typically developing (TD) children. Results: Compared to TD children, patients had higher internalizing and externalizing CBCL scores and higher rates of clinically relevant externalizing problems. However, the rates of clinically relevant internalizing problems and mental disorders did not differ. The parents of children with incontinence reported significantly higher stress levels regarding child-related stress factors (PSI-CD) than did parents of TD children. However, there were no clinically relevant parental stress scores on a group level, which remained below the clinical range (T-value < 60). When simultaneously analyzed, children’s (comorbid) mental disorders but not incontinence had a major impact on parental stress. Conclusions: Despite moderate stress levels, incontinence symptoms, urinary and fecal incontinence are highly prevalent in young children. However, stress among parents of young children was mainly elicited by any (comorbid) mental disorder.

Aims Tuberous sclerosis complex (TSC) is a multisystem genetic disorder caused by a mutation in the TSC1 or TSC2 gene with a broad spectrum of physical and psychological manifestations. The aim of the study was to examine incontinence, psychological problems, and adaptive behavior skills in patients with TSC. Methods Through a worldwide TSC support group, 26 children (4-17 years) and 15 adults (18-50 years) with TSC were recruited (38.1% male, mean age 16.4 years). Parents or care-givers completed the Developmental Behavior Checklist (DBC), the Parental Questionnaire: Enuresis/urinary Incontinence, and the Vineland Adaptive Behavior Scales (3rd edition). Results A total of 60.0% of the participants had nocturnal enuresis (NE), 51.3% daytime urinary incontinence (DUI) and 52.4% fecal incontinence (FI). 65.4% of children and 50.0% of adults had a clinically relevant DBC score. Psychological symptoms were associated with at least one subtype of incontinence. The mean adaptive behavior composite (ABC) score of the patients was 57.2 (SD = 26.1), with 38.1% in the average or below-average range (IQ >70), 26.2% with a mild, 11.9% with a moderate and 23.8% with a severe/profound intellectual disability. The incontinence rate was significantly higher in the groups with a lower ABC score. Conclusion A substantial proportion of patients with TSC are affected by incontinence and psychological symptoms. Incontinence was higher in persons with lower adaptive skills and those with at least one type of incontinence showed a significantly higher DBC score. As incontinence and psychological problems affect daily functioning and well-being, assessment, and treatment are recommended.

European child & adolescent psychiatry 30(7), 1081-1094 (2021). doi:10.1007/s00787-020-01595-4, Published by Steinkopff, Darmstadt

There are several recommendations that assessing childrens’ or adolescents’ spiritual needs is important, while there are no studies available, however, that have systematically assessed adolescents’ spiritual needs with a validated instrument. Therefore, the adolescent version of the SpNQ (SpNQ-Ad) was applied in a group of 200 adolescents with either somatic diseases or psychosomatic/psychiatric conditions that required treatment. Among these adolescents, Attention/Positive Confirmation needs scored highest, followed by Inner Peace needs and Existential/Giving needs, while Religious needs were of lowest relevance. Here, female adolescents had significantly higher Attention/Positive Confirmation needs and Existential/Giving needs than male persons. Religious/Praying needs were predicted best by frequency of private praying and belief in God, while Attention/Positive Confirmation needs were predicted best by affections of daily life through disease-related symptom. Existential/Generativity needs and also Inner Peace needs were predicted best by reflecting on meaning in life. Thus, also adolescents with chronic conditions or long-lasting treatments from a secular society have unmet spiritual needs that are important to them. These have to be care-fully addressed and supported.

Elimination disorders - ICD-11 classification and definitions

Aims Chronic urinary retention occurring in young women is poorly understood and a cause may not be found in a majority of cases. Different psychological comorbidities and functional neurological symptom disorders (FNDs) have been reported; however, these have been poorly explored. Methods At the International Consultation on Incontinence Research Society meeting in 2019, a panel of clinicians generated a proposal to explore the relationship between psychological comorbidities, FNDs, and urinary retention in women with chronic idiopathic urinary retention. Results Psychological comorbidities such as depression and anxiety, and FNDs such as leg weakness and loss of consciousness, have been reported in women with idiopathic urinary retention. Individuals react differently to physical and emotional stressors, and experimental models have demonstrated a relationship between the stress response and developing urinary retention. Trauma, particularly sexual trauma, may be a shared risk factor for developing psychological comorbidities and urinary retention. Children with voiding postponement often suffer from psychological comorbidities and behavioral disturbances; however, there is no evidence to suggest that this progresses to urinary retention in adulthood. "Psychogenic urinary retention" has been described in the urology and psychiatry literature in the past, and anecdotal cases of successful voiding following psychotherapy have been reported, though the true pathophysiology of this entity is uncertain. Conclusion Psychological and functional disorder comorbidities are reported in women with chronic urinary retention. The nature of the association between urinary retention and functional neurological disorder comorbidities needs to be further explored in terms of a disorder of bladder-brain interaction.

Incontinence, psychological symptoms, parental stress and psychopathology were examined in 51 children (43 boys, mean age = 9.7 years) presented in an outpatient clinic for autism spectrum disorders (ASD) and in 53 matched controls (43 boys, mean age = 10.2 years). All children were clinically assessed for ASD, incontinence and psychopathology according to current guidelines. ASD was confirmed in 37 children and excluded in 14. Enuresis (16.2%) and daytime urinary incontinence (16.2%), but not fecal incontinence (8.2%) were more common in ASD than in controls. Children with ASD showed significantly more comorbid psychiatric disorders. Parents of children with ASD experience more stress. Parental stress was predicted by parental psychopathology, role restriction and group (patient/control), but not by incontinence.

Abstract. Objective: Fecal incontinence and constipation are common disorders in childhood. The enteric nervous system and the central nervous system are highly interactive along the brain-gut axis. The interaction is mainly afferent. These afferent pathways include centers that are involved in the central nervous processing of emotions as the mid/posterior insula and the anterior cingulate cortex. A previous study revealed altered processing of emotions in children with fecal incontinence. The present study replicates these results. Methods: In order to analyze the processing of emotions, we compared the event-related potentials of 25 children with fecal incontinence and constipation to those of 15 control children during the presentation of positive, negative, and neutral pictures. Results: Children with fecal incontinence and constipation showed altered processing of emotions, especially in the parietal and central cortical regions. Conclusions: The main study results of the previous study were replicated, increasing the certainty and validity of the findings.

Elimination disorders (EDs) encompass faecal incontinence or encopresis, daytime urinary incontinence, and nocturnal enuresis. Many different subtypes can be identified. EDs are common disorders in childhood, associated with emotional distress and a higher rate of comorbid psychiatric disorders such as attention-deficit/hyperactivity disorder. These have to be addressed separately. Genetic and environmental factors play a role in the aetiologies of EDs. Medical causes have to be ruled out, but most EDs are functional, that is, non-organic. Assessment is non-invasive and clinically based in most cases. Treatment is symptom-oriented, with the goal of complete continence. The most effective treatment is primarily by urotherapy, cognitive behavioural therapy, and medication. As each subtype of ED requires a specific treatment approach, an exact diagnosis is essential. International guidelines are available to ensure optimal care for children and adolescents with EDs.

The objective of the study was to examine the association between biopsychosocial factors and developmental trajectories of childhood urinary incontinence (UI). We used developmental trajectories (latent classes) of childhood UI from 4–9 years including bedwetting alone, daytime wetting alone, delayed (daytime and nighttime) bladder control, and persistent (day and night) wetting (n = 8751, 4507 boys, 4244 girls). We examined whether biopsychosocial factors (developmental level, gestational age, birth weight, parental UI, temperament, behaviour/emotional problems, stressful events, maternal depression, age at initiation of toilet training, constipation) are associated with the trajectories using multinomial logistic regression (reference category = normative development of bladder control). Maternal history of bedwetting was associated with almost a fourfold increase in odds of persistent wetting [odds ratio and 95% confidence interval: 3.60 (1.75–7.40)]. In general, difficult temperament and behaviour/emotional problems were most strongly associated with combined (day and night) wetting, e.g. children with behavioural difficulties had increased odds of delayed (daytime and nighttime) bladder control [1.80 (1.59–2.03)]. Maternal postnatal depression was associated with persistent (day and night) wetting [2.09 (1.48–2.95)] and daytime wetting alone [2.38 (1.46–3.88)]. Developmental delay, stressful events, and later initiation of toilet training were not associated with bedwetting alone, but were associated with the other UI trajectories. Constipation was only associated with delayed bladder control. We find evidence that different trajectories of childhood UI are differentially associated with biopsychosocial factors. Increased understanding of factors associated with different trajectories of childhood UI could help clinicians to identify children at risk of persistent incontinence. Electronic supplementary material The online version of this article (10.1007/s00787-018-1193-1) contains supplementary material, which is available to authorized users.