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

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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.

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References

  1. von Gontard A, Neveus T (2006) Management of disorders of bladder and bowel control in childhood. MacKeith Press, London

    Google Scholar 

  2. von Gontard A (2012) Enuresis. In: J Rey J (ed) IACAPAP Textbook of Child and Adolescent Mental Health, online, 2012; http://iacapap.org/iacapap-textbook-of-child-and-adolescent-mental-health

  3. von Gontard A (2012) Encopresis. In: Rey J (ed) IACAPAP Textbook of Child and Adolescent Mental Health. http://iacapap.org/iacapap-textbook-of-child-and-adolescent-mental-health

  4. Nevéus T, von Gontard A, Hoebeke P, Hjälmås K, Yeung CK, Vande Walle J, Rittig S, Jørgensen TM, Bower W, Bauer S, Djurhuus JC (2006) The standardization of terminology of lower urinary tract function in children and adolescents: report from the Standardization Committee of the International Children’s Continence Society (ICCS). J Urol 176:314–324

    Article  PubMed  Google Scholar 

  5. Rasquin A, Di Lorenzo C, Forbes D, Guiraldes E, Hyams JS, Staiano A, Walker LS (2006) Childhood functional gastrointestinal disorders: child/adolescent. Gastroenterology 130:1527–1537

    Article  PubMed  Google Scholar 

  6. von Gontard A (2011) Elimination disorders—a critical comment on DSM-5 proposals. Eur Child Adolesc Psychiatry 20:83–88

    Article  Google Scholar 

  7. Hoebeke P, Bower W, Combs A, De Jong T, Yang S (2010) Diagnostic evaluation of children with daytime incontinence. J Urol 183:699–703

    Article  PubMed  CAS  Google Scholar 

  8. Vande Walle J, Rittig S, Bauer S, Eggert P, Marschall-Kehrel D, Tekgul S (2012) Practical consensus guidelines for the management of enuresis. Eur J Pediatr 171:971–983

    Article  PubMed  Google Scholar 

  9. NICE clinical guideline 111 (2010) Nocturnal enuresis—the management of bedwetting in children and young people. National Institute for Health and Clinical Excellence, London

  10. Neveus T, Eggert P, Macedo A, Rittig S, Tekgul S, Vande Walle J, Yeung CK, Robson L (2010) Evaluation of and treatment for monosymptomatic enuresis: a standardization document from the International Children’s Continence Society. J Urol 183:441–447

    Article  PubMed  Google Scholar 

  11. Chase J, Austin P, Hoebeke P, McKenna P (2010) The management of dysfunctional voiding in children: a report from the standardisation committee of the International Children’s Continence Society. J Uro 183:1296–1302

    Article  Google Scholar 

  12. von Gontard A (2007) Enuresis und funktionelle Harninkontinenz. In: Schmidt MH, Poustka F (eds) Leitlinien zur Diagnostik und Therapie von psychischen Störungen im Säuglings-, Kindes- und Jugendalter, 3rd edn. Köln, Deutsche Ärzteverlag, pp 327–342

    Google Scholar 

  13. von Gontard A (2007) Enkopresis. In: Schmidt MH, Poustka F (eds) Leitlinien zur Diagnostik und Therapie von psychischen Störungen im Säuglings-, Kindes- und Jugendalter, 3rd edn. Köln, Deutscher Ärzteverlag, pp 343–356

    Google Scholar 

  14. von Gontard A, Baeyens D, Van Hoecke E, Warzak W, Bachmann C (2011) Psychological and psychiatric issues in urinary and fecal incontinence. J Urol 185:1432–1437

    Article  Google Scholar 

  15. AACAP (2004) Practice parameter for the assessment and treatment of children and adolescents with enuresis. J Am Acad Child Adolesc Psychiatry 43:1540–1550

    Article  Google Scholar 

  16. NICE clinical guideline 99 (2010) Constipation in children and young people—diagnosis and management of idiopathic childhood constipation in primary and secondary care. National Institute for Health and Clinical Excellence, London

  17. Felt B, Wise CG, Olsen A, Kochhar P, Marcus S, Coran A (1999) Guideline for the management of pediatric idiopathic constipation and soiling. Arch Pediatr Adolesc Med 153:380–385

    PubMed  CAS  Google Scholar 

  18. Equit M, Sambach H, Niemczyk J, von Gontard A (2013) Blasen- und Darmschulung: Gruppentherapie für Kinder und Jugendliche mit komplexen Ausscheidungsstörungen. Hogrefe, Göttingen

    Google Scholar 

  19. Equit M, Sambach H, El Khatib D, Schreiner-Znik S, von Gontard A (2011) Therapieresistente Harninkontinenz und Enuresis. Monatsschr Kinderheilkd 159(565–571):2011

    Google Scholar 

  20. Glazener CMA, Evans JHC, Peto RE (2005) Alarm interventions for nocturnal enuresis in children. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD002911

  21. Glazener CMA, Evans JHC (2004) Simple behavioural and physical interventions for nocturnal enuresis in children. In: Cochrane Database Syst Rev. CD003637

  22. Glazener CMA, Evans JHC, Peto RE (2008) Complex behavioural and educational interventions for nocturnal enuresis in children. Cochrane Database of Syst Rev 2004, Issue 1. Art. No.: CD004668

  23. Glazener CMA, Evans JHC (2006) Desmopressin for nocturnal enuresis in children. Cochrane Database Syst Rev 2002, Issue 3. Art. No.: CD002112

  24. Glazener CMA, Evans JHC, Peto RE (2007) Tricyclic and related drugs for nocturnal enuresis in children. Cochrane Database Syst Rev 2003, Issue 3. Art. No.: CD002117

  25. Glazener CMA, Evans JHC, Peto RE (2007) Drugs for nocturnal enuresis in children (other than desmopressin and tricyclics). Cochrane Database Syst Rev 2003, Issue 4. Art. No.: CD002238

  26. Huang T, Shu X, Huang YS, Cheuk DKL (2011). Complementary and miscellaneous interventions for nocturnal enuresis in children. Cochrane Database Syst Rev 2011, Issue 12. Art. No.: CD005230

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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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  1. Department of Child and Adolescent Psychiatry, Saarland University Hospital, 66421, Homburg, Germany

    Alexander von Gontard

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  1. Alexander von Gontard
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Correspondence to Alexander von Gontard.

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von Gontard, A. The impact of DSM-5 and guidelines for assessment and treatment of elimination disorders. Eur Child Adolesc Psychiatry 22 (Suppl 1), 61–67 (2013). https://doi.org/10.1007/s00787-012-0363-9

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  • DOI: https://doi.org/10.1007/s00787-012-0363-9

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