Psychological Issues Associated with Enuresis
Psychological issues Early referral Neuromodulation Psychological issues [68] Psychological issues are well described as being associated with the pathogenesis of enuresis. Subclinical symptoms include sadness, moodiness, embarrassment and guilt. Enuresis leads to a lower quality of life for the patient and caregivers. Several clinical conditions are associated with enuresis: externalising disord
Psychological issues[68]
Psychological issues are well described as being associated with the pathogenesis of enuresis. Subclinical symptoms include sadness, moodiness, embarrassment and guilt. Enuresis leads to a lower quality of life for the patient and caregivers. Several clinical conditions are associated with enuresis:
- externalising disorders (attention deficit/hyperactivity disorder (ADHD), conduct disorder)
- internalising disorders (depression, anxiety)
- mixed disorders (autism spectrum disorder, anorexia).
Psychological Screening
There are validated psychological screening modalities available that can be performed in waiting rooms before consultation:
- Short Screening Instrument for Psychological Problems in Enuresis (SSIPPE)[69]
- Child Behaviour Checklist (CBCL).[70]
In refractory cases, a high suspicion of non-adherence is essential and psychological screening is critical.
Early Referral
A multidisciplinary approach is essential if an underlying psychological disorder is suspected. Early referral should be done for a formal psychological assessment and early management if indicated.
High-risk groups for a negative impact on quality of life are female gender and patients at an older age.[71] These patients may require expedited psychological referral.
Neuromodulation[51-53]
There is a role for neuromodulation in adolescents and older children with refractory enuresis that causes severe psychological distress. Transcutaneous electrical neurostimulation is non-invasive and stimulates the sacral nerves over S2 - S4, controlling detrusor contractions. This modality should only be considered by experts in dealing with refractory enuresis. We do not routinely suggest using neuromodulation therapy for children with NE, although it was found to be safe and effective in a meta-analysis compared with placebo/control in some cases of refractory enuresis. The risk of relapse and the optimal type of electrical stimulation in comparison with other interventions for NE are uncertain.
The South African Medical Journal_The South African guidelines on enuresis: 2024 update_November 2024; Vol. 114, No. 11