Functional daytime incontinence: non-pharmacological treatment

Scand J Urol Nephrol Suppl. 1992:141:93-103; discussion 104-5.

Abstract

In children with 'functional incontinence', defined as any form of (daytime) wetting caused by non-neuropathic bladder/sphincter dysfunction, most signs and symptoms are rooted in habitual non-physiological responses to signals from bladder and urethra. These responses develop at toddler age, when children learn how to remain dry. Once they have become a habit, incomplete bladder emptying and recurrent urinary tract infections come into play, reiterating the non-physiological responses into fixed patterns of bladder/sphincter dysfunction with functional incontinence as the leading symptom. Non-pharmacological treatment of functional incontinence implies relearning and training the normal responses to signals from bladder and urethra: a cognitive process, with perception of the signals reinforced by biofeedback. This type of treatment is best combined with long-term chemoprophylaxis. Severe cases will benefit from anticholinergic drugs, as adjuvants to the training programme. Urodynamics play a crucial role in documenting the specific patterns of incontinence and in providing biofeedback. For a successful programme, psychological screening of the children is indispensable.

MeSH terms

  • Adolescent
  • Biofeedback, Psychology*
  • Child
  • Child, Preschool
  • Chronic Disease
  • Cognitive Behavioral Therapy*
  • Follow-Up Studies
  • Humans
  • Recurrence
  • Time Factors
  • Urinary Incontinence / complications
  • Urinary Incontinence / physiopathology
  • Urinary Incontinence / psychology
  • Urinary Incontinence / therapy*
  • Urinary Tract Infections / complications