Cognitive-behavioral stress management training for boys with functional urinary incontinence.

OBJECTIVE: To evaluate an inpatient education program involving cognitive-behavioral stress management training of boys (aged 8-12 years) with functional urinary incontinence. METHODS: The short- and long-term intervention effects of the new program on incontinence frequency, quality of life, and coping with daily and illness-related stressors were investigated in 15 boys, compared to 10 boys on a more knowledge-oriented education program without stress management. The efficacy was evaluated by non-parametric methods. RESULTS: In both groups daytime wetting decreased while adaptive coping with daily stressors increased. Only the boys in the experimental group improved their wetting frequency during the night, maladaptive coping with illness-related stressors, and self-esteem. CONCLUSIONS: Stress management training should be incorporated in patient education programs to enhance coping of children with illness-related stressors and low self-esteem.

Prospective evaluation of inpatient and outpatient bladder training in children with functional urinary incontinence.

OBJECTIVES: To evaluate, in a prospective study, the effectiveness of a bladder training program. Daytime and/or nighttime wetting as a consequence of functional urinary incontinence is a common problem in childhood. Various treatment options are available, including with cognitive-behavioral "bladder training." METHODS: Sixty patients (age 8 to 12 years) with urge incontinence or dysfunctional voiding were evaluated. After a no-treatment control period (average 6 months), patients underwent a 6-day bladder training course, which was offered either as inpatient or outpatient training, leaving the choice to the patients' parents. Clinical assessments were recorded at the beginning of the control period, at training entry and training completion, and after 1 (inpatient training group only), 3, and 6 months. RESULTS: Six months after training completion, 64.1% and 64.7% of the inpatient and outpatient groups with daytime wetting and 51.5% and 17.7% of the inpatient and outpatient groups with nighttime wetting were cured or had improved, respectively. The spontaneous cure rate during the 6-month control period was 0% to 20.5%. Of the inpatient group with urge incontinence, the functional bladder capacity increased by 15%. The children aged 9 to 12 years in the inpatient group had significantly greater cure rates than the 8-year-old children. CONCLUSIONS: Compared with the control period, the bladder training program evaluated in this study resulted in significantly greater success rates. The results lead to the assumption that children with nighttime wetting treated in the inpatient training will succeed better than those in outpatient training. The cure and improvement rates of daytime wetting were greater than those for nighttime wetting.

[Enuresis: pathogenesis, diagnostics, and interventions]. / Enuresis: Erklärungsansätze, Diagnostik und Interventionsverfahren.

This review summarizes the current scientific knowledge on enuresis. Enuresis is one of the most common disorders in childhood. New conclusions on classification, aetiology, clinical diagnostics and therapy could be drawn in the past years. Thus, recent results have shown that the previous classification of enuresis into nocturnal, diurnal and diurnal and nocturnal forms which is suggested by DSM-IV and ICD-10 is not sufficient. Daytime wetting consists of a heterogeneous group of syndromes, which should be considered as functional urinary incontinence. Primary nocturnal enuresis is mainly caused by biological factors. In contrast, psychosocial factors play an important role in the manifestation of the disease, especially in secondary enuresis. Diagnostical and therapeutical concepts have to consider the heterogeneity of this disorder. Evaluation studies were supported by effective intervention programs for nocturnal enuresis. But beneficial effects of treatments for functional urinary incontinence were not confirmed.

[Obesity and coping in childhood]. / Adipositas und Stressverarbeitung im Kindesalter.

The aim of this study was to investigate everyday coping styles in obese children in comparison to healthy controls in dependence of gender. Furthermore, the correlations of eating behavior with coping styles were examined. In addition, groups with highest and lowest extremal scores in eating behavior were compared. Patients (N = 58) aged from 11 to 13 years, who took part in an in-patient education program, were asked to complete the German Coping Questionnaire for Children and Adolescents (Hampel et al. 2001) and the Dutch Eating Behavior Questionnaire for Children (Franzen u. Florin 1997). Healthy controls were matched by age and gender and were asked to fill out the SVF-KJ. No differences between coping styles of obese children and adolescents and healthy controls were found. In obese children and adolescents, emotional and external eating behavior were positively correlated with maladaptive coping strategies. In comparison to previous findings in chronically ill children, differences in obese children and adolescents and healthy controls on coping styles could not be confirmed in the present study. However, results support that the eating behavior of obese children and adolescents is influenced by coping styles.