Psychiatry and Clinical Psychopharmacology

Treatment update in elimination disorders based on new scientific findings

Psychiatry and Clinical Psychopharmacology 2013; 23: Supplement S48-S49
Read: 553 Published: 21 March 2021

Elimination disorders are very common in children; 10% of seven year-old wet at night (nocturnal enuresis), 2-3% during daytime (diurnal urinary incontinence) and 1-3% soil (encopresis). They are associated with significant comorbid psychopathology and are distressing for children and parents. Nocturnal enuresis is the intermittent involuntary loss of urine at night, in the absence of physical disease, at an age when a child could reasonably be expected to be dry (by consensus, at a developmental age of five years). Many different types of drugs have been used to treat children with nocturnal enuresis. Alarms triggered by wetting, desmopressin and tricyclic drugs have been shown to work during treatment. According to the International Children’s Continence Society, alarms and desmopressin are recommended as first-line nocturnal enuresis therapies for monosymptomatic enuresis. Desmopressin is safe and acts quickly, especially on nocturnal polyuric enuresis, but does not cure the disorder and results in a high relapse rate. Enuresis alarms support dryness in approximately two-thirds of children with enuresis and result in low relapse rates after successful therapy; however, long-term therapy is required to achieve complete success. Although drug therapies other than desmopressin or tricyclics have been tried for nocturnal enuresis[non-steroidal anti-inşammatory drugs (indomethacin and diclofenac), psychoactive drugs (e.g. amphetamine, diazepam, meprobamate, hydroxyzine, ephedrine sulphate), anticholinergics (oxybutynin) and other drugs (methylphenidate, atomoxetine, sertraline)], little is known of their impact. Behavioral and other interventions include enuresis alarm therapy and overlearning, complex behavioral interventions (e.g. dry bed training), multi-dimensional behavioral training and simple behavioral interventions (e.g. retention control training, şuid deprivation). Other interventions include complementary and miscellaneous interventions such as acupuncture, hypnosis, chiropractic and homeopathy. Encopresis is defined as a disorder characterized by repeated passage of feces into inappropriate places in a child who is at least four years old. DSM-IV also acknowledges two subtypes of encopresis: with or without constipation and overşow incontinence. The former corresponds to what has generally been referred to as retentive encopresis, while the latter would correspond to nonretentive encopresis. A child should be at least 4 years of age with faecal incontinence younger children do not require treatment. Comorbid emotional and behavioral disorders should be treated separately according to evidence-based recommendations. Change in toileting habits or augmenting oral şuids can be very effective. Toilet training (regular sitting on the toilet after mealtimes) is the main component in the treatment of encopresis. Medication can be indicated in faecal incontinence with constipation (polyethylene glycol). Comorbid behavioral and emotional disorders require additional treatment.

EISSN 2475-0581