Psychosomatic Perspective Is Missing
by Alexander von Gontard and Eberhard Kuwertz-Bröking in issue 16/2019
Micturition disorders occur temporarily in almost every child, either as wetting or as incontinence (1), but also—especially in girls—as a cause of recurrent urinary tract infections (2). The importance of the interactional aspect between the parents’ desire to control the child’s bladder function on the one hand and, on the other hand, the child’s struggle for autonomy (3), is not sufficiently considered here (4). This also applies to the S2k guideline “Enuresis and Non-organic (Functional) Urinary Incontinence in Children and Adolescents” of the Association of the Scientific Medical Societies in Germany (AWMF).
In micturition disorders, there are certainly also established habits that are easy to treat with behavioral therapy and that have no psychopathological background. But quite often, an interaction disturbance is playing out at this level, which requires an approach that takes into account the psychosocial situation, the experiences, and the needs of the child.
The gradual control over bowel and bladder function in the second to the fourth year of life is an important developmental step that is carefully watched over by parents and should be supported with care, but which has numerous possibilities for disturbances. If a battlefield is created here in which power struggles are carried out, then—similar to sleeping and eating behavior—living together becomes a daily struggle, in which there can only be losers.
Generally speaking, enuresis and functional urinary incontinence represent a childhood psychosomatic disorder. Stressful psychosocial factors are frequently observed. It is important for physicians in everyday practice, when presented with symptoms of enuresis and functional urinary incontinence, to think of a micturition disorder, and then— taking the child’s circumstances into account—consider this in the psychodynamic context of autonomy versus control.
Dr. med. Stephan Heinrich Nolte
Practice for General Pediatrics, Psychotherapy, Palliative Care
Conflict of interest statement
The author declares that no conflict of interest exists.
|1.||Lettgen B, von Gontard A, Olbing H, et al. Urge incontinence and voiding postponement in children: somatic and psychosocial factors. Acta Paediatrica 2002; 91: 978–84 CrossRef CrossRef MEDLINE|
|2.||Anders D: Mädchen mit rekurrierenden Harnwegsinfektionen, alte Probleme aus neuer Sicht. Therapiewoche 1984; 34: 907–19.|
|3.||Nolte SH: Der psychosomatische Zugang zu Miktionsstörungen und Harnwegsinfektionen. Ärztl Psychoth 2019; 14: 167–72.|
|4.||von Gontard A, Kuwertz-Bröking E: The diagnosis and treatment of enuresis and functional daytime urinary incontinence. Dtsch Arztebl Int 2019; 116: 279–85 VOLLTEXT|