The Psychological Effects of Bedwetting, Daytime Urinary and Fecal Incontinence

By Dawn Sandalcidi, PT, PCMT, BCB-PMD

A regular referring pediatrician called me one morning to tell me about an 11-year-old boy who hung himself secondary to fecal incontinence and persistent teasing by his siblings and peers. Her comment to me was “If his parents only knew about the services you offer this child’s life may have been spared.”  That was over 10 years ago and to this day I still get emotional just thinking about it.

Children who suffer from constipation with or without encopresis (fecal incontinence), daytime urinary leakage, nighttime leakage or bedwetting suffer tremendously. The psychological test scores of these children are abnormal at the time of diagnosis however the interesting piece is that once their bowel and/or bladder issues are resolved, their psychological test scores return to normal.  (Hinman 1986, Sureshkumar, 2009; Joinson 2007.)

It is clear that these disorders CAUSE psychological disturbances rather than the reverse being true. Can you imagine having such angst as a child AND parent dealing with poor self-esteem, embarrassment, shame, anxiety (I could go on) which can develop into oppositional defiance disorders, internalizing and externalizing psychological behaviors?

Here are the statistics:

·         20-30% of children with bedwetting fulfill the criteria for psychiatric disorders with a 2-4x higher rate as compared to non-wetting children; (von Gontard, Neveus 2006)

·         Bedwetters who are punished by their parents exhibit depression and reduced quality of life (Al-Zaben 2014)

·         Children who wet during the day and at night exhibit more fear and anxiety (van Gontard 2011, 2014).

·         20-40% of children with daytime incontinence fulfill the criteria for psychiatric disorders- (von Gontard, Neveus 2006)

·         Daytime wetters tend to exhibit internalizing behaviors such as depression, anxiety and withdrawal and nighttime bed wetters tend be exhibit more externalizing behaviors such as aggression and acting out. (Kodman 2001).

·         Children who postpone voiding exhibit more externalizing disorders-especially oppositional defiant disorder (ODD). More than 50% fulfill criteria for at least 1 psychological disorder(von Gontard et al 1998, Zink et al, 2008) and it affects the family (Lettgen et al. 2002)

·         30-50% of children with fecal incontinence fulfill the criteria for psychiatric disorders and exhibit both internalizing and externalizing disorders. (von Gontard, Neveus 2006)

Helping families who have kiddos with bowel or bladder leakage is not only a passion but also a privilege and an obligation!!