The psychosomatic perspective is important and plays a crucial role in clinical practice. However, based on recent findings, it must be considered in a differentiated way.
First, micturition disorders are not as common as claimed by Dr. Nolte. Most children have no lower urinary tract disorders. Also, most children with incontinence have no accompanying mental disorder (1). If a comorbid disorder does exists, then, according to the guidelines, it should be treated separately.
Furthermore, the etiologies of the subtypes of incontinence are very different. For example, urinary incontinence with voiding postponement is a predominantly acquired disorder associated with a high rate of oppositional defiant disorder (ODD). Among other effects, this can lead to the conflicts of autonomy described by Dr. Nolte.
Nocturnal enuresis, on the other hand, is a predominantly genetically determined maturation disorder of the central nervous system, with a heritability of 0.7. Providing information about the genetic etiology as well as targeted, effective therapeutic interventions—that is, treating the child with an alarm device—contributes greatly to the relief of the parents. The most common comorbid disorder of nocturnal enuresis is attention deficit/hyperactivity disorder (ADHD), which is also a predominantly genetically determined, neurobiological developmental disorder.
In summary, taking psychological factors into account is important in both diagnosis and therapy. Therefore, all children with enuresis and urinary incontinence should be assessed for comorbid mental disorders. However, the statement that elimination disorders are predominantly psychosomatic must be contradicted. Nonetheless, a differentiated consideration of somatic and psychological factors in subtypes of enuresis and urinary incontinence is absolutely necessary.
Prof. Dr. med. Alexander von Gontard
Klinik für Kinder- und Jugendpsychiatrie
Psychotherapie und Psychosomatik
Universitätsklinikum des Saarlands
Conflict of interest statement
Prof. von Gontard has received third-party funds from Novartis as study support for self-initiated research. He has received author honoraria from the publishing companies Hogrefe, Kohlhammer, Wiley, and Max Keith Press.
|1.||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|