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Challenging factors for enuresis treatment: Psychological problems and non-adherence
By Charlotte Van Herzeele, Pauline De Bruyne, Elke De Bruyne, and Johan Vande Walle
Journal of Pediatric Urology 2015: 1–6. Available at: http://linkinghub.elsevier.com/retrieve/pii/S1477513115002302
Article in Press, Corrected Proof
It is not a secret if I state that there are no “easy solutions in the treatment of nocturnal enuresis”, but rather time-consuming efforts which require motivation from both children and parents. The compliance or “adherence” of the child and the parents, as it is mentioned in this article, is the cornerstone of treatment success. It has not always been clear if psychological comorbidity is the result of nocturnal enuresis or a “risk” factor for the outcome and treatment choice or option. In this article, the authors review a number of publications in which the psychological symptoms and nocturnal enuresis have been studied. Their conclusions are clear: the involvement of psychopathology is underestimated and coincides with therapy resistance. The authors plead for the use of a minimal psychological screening tool before starting any kind of treatment for nocturnal enuresis in order to improve the success of treatment. And, according to my personal experience, in order to improve the satisfaction of the child and his/her parents.
The evidence for organic pathogenetic factors in enuresis and the discovery of effective therapies targeting the bladder and/or nocturnal diuresis have overwhelmed every potential role of psychological factors in pathogenesis and treatment. However, psychopathology is still important in enuresis because according to the document of the International Children's Continence Society (ICCS) 20-30% of the children with enuresis have at least one psychological/psychiatric disorder at rates two times higher than non-wetting children. The most common comorbid disorder with enuresis is attention deficit hyperactivity disorder. The aim of this review is to translate the existing evidence on the importance of a psychological screening into daily clinical practice of the medical practitioner. The use of the minimal psychological screening tool should be considered mandatory in each primary setting. If psychological problems are indicated, referral of the patient to a multidisciplinary setting should be considered, not only to allow psychological assessment to screen for a possible psychopathology, but also since therapy resistance might be expected. This review concentrates on two items from psychopathology/psychotherapy that might predict insufficient treatment response: the psychological comorbidities as described according to the DSM-5 criteria and the underestimated importance of therapy adherence. Adherence is a cornerstone of effective therapy in enuresis. It is a problem involving the doctor, the patient, and the parents. Increasing adherence takes effort and is time-consuming. But it is worthwhile knowing that several studies have demonstrated that high adherence is associated with high therapy success of enuresis. Eventually, this is the ultimate goal of treatment.
Copyright © 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.