Does psychological stress affect LUT function in children?: ICI‐RS 2011

AIMS: Psychological factors and LUTS are closely associated in children. 20-40% of children with nocturnal enuresis (NE) and 30-40% with daytime urinary incontinence (DUI) have a clinical psychiatric disorder, many more are distressed. The associations are complex and differ for each individual subtype of disorder, as both genetic and environmental factors can interact. The aim of this paper is to provide an overview and discuss possible causal associations. METHODS: Relevant studies are reviewed--preferably with population-based, representative results. RESULTS: Four basic associations are possible. Psychological symptoms and disorders can (1) be a consequence of LUTS and NE/DUI; (2) They can be induced by them; (3) Both can be due to common, shared etiological factors; and (4) They can co-occur by chance without causality. CONCLUSIONS: Due to these complex associations, a descriptive approach is endorsed. Both the subtype of NE/DUI and possible psychological symptoms and disorders need to be identified--possible causal relationships can be analyzed in a second step. Screening for psychological symptoms with parental behavioral questionnaires in all settings is recommended, as well as counselling and treatment if indicated.