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European Child & Adolescent Psychiatry

, Volume 22, Supplement 1, pp 61–67 | Cite as

The impact of DSM-5 and guidelines for assessment and treatment of elimination disorders

  • Alexander von GontardEmail author
Review

Abstract

Elimination disorders are very common in children: 10 % of 7-year-olds wet at night (nocturnal enuresis), 2–3 % during daytime (diurnal urinary incontinence) and 1–3 % soil (faecal incontinence). In the past decades, many subtypes of elimination disorders have been identified with different symptoms, aetiologies, comorbid disorders and specific treatment options. The aim of the paper is to present a short overview of the proposed DSM-5, the ICCS and the Rome-III classification systems, of assessment and of treatment. The DSM-5 criteria no longer reflect current research data and a revision is needed. Classification systems of the International Children’s Incontinence Society (ICCS) for enuresis and urinary incontinence and the ROME-III criteria for functional gastrointestinal disorders offer new and relevant suggestions for both clinical and research purposes. Assessment of most elimination disorders can be performed in paediatric and child psychiatric primary care settings. The standard assessment consists of a thorough history, frequency/volume charts, specific questionnaires, a full physical examination, sonography and urinalysis. If possible, a child psychiatric assessment is performed. In all other settings, screening with a validated behavioural questionnaire and referral if indicated is recommended. All other investigations are indicated only in complicated cases and if an organic cause is to be ruled out. Treatment is symptom oriented and based on the exact diagnosis of the type of elimination disorder. Counselling is recommended in every case. Most elimination disorders can be treated by specific treatment programmes integrating cognitive-behavioural elements. Nocturnal enuresis is best treated with alarms. Medication can be indicated in nocturnal enuresis (desmopressin), urge incontinence (anticholinergics such as oxybutynin, propiverine, etc.) and faecal incontinence with constipation (polyethylene glycol). Comorbid behavioural and emotional disorders require additional treatment.

Keywords

Nocturnal enuresis Daytime urinary incontinence Encopresis Faecal incontinence Guidelines for assessment Guidelines for treatment DSM-5 Rome-III ICCS 

Notes

Conflict of interest

The corresponding author states that there are no conflicts of interest. This article is part of the supplement ‘‘The Future of Child and Adolescent Psychiatry and Psychology: The Impact of DSM 5 and of Guidelines for Assessment and Treatment”. This supplement was not sponsored by outside commercial interests.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Department of Child and Adolescent PsychiatrySaarland University HospitalHomburgGermany

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