[Elimination disorders in childhood. How to make children dry and clean].MMW Fortschr Med 2003; 145(27-28):26-30MF
Evacuation disorders include a number of disturbances in which genetic and environmental factors play a highly differentiated role. Behind enuresis nocturna is a genetic CNS development disorder; a differentiation is made between cases with and without diurnal bladder dysfunction. In the first line treatment involves the use of an alarm device, while desmopressin is a second-choice treatment. In children with diurnal enuresis, there is a range of functional disorders of continence to be considered including, in particular, idiopathic urge incontinence, urinary incontinence when micturition is suppressed, and detrussor sphincter dyscoordination. Prominent among the therapeutic options are cognitive-behavioral measures and biofeedback training. Encopresis may develop on the soil of acute constipation or underlying psychological factors. Treatment is symptom-oriented and also comprised behaviorial measures (toilet training), possibly dietary measures and, in the event of constipation, enemas or oral laxatives.