Psychological and Psychiatric Issues in Functional Constipation, Fecal Incontinence and Bladder and Bowel Dysfunction-A Revised and Updated Document of the International Children's Continence Society (ICCS)

Purpose
The aim is to provide an updated and revised overview of psychological and psychiatric aspects of fecal incontinence (FI), functional constipation (FC), non-retentive FI (NRFI) and bladder and bowel dysfunction (BBD). Clinical behavioral disorders and subclinical psychological symptoms are reviewed. Aspects of screening, assessment, counseling, and in severe cases, treatment are outlined and recommendations are formulated.

Methods
Relevant publications on psychological and psychiatric aspects are reviewed. The recommendations passed several rounds of consensus finding and were circulated among ICCS board members.

Results
In addition to subclinical effects on self-esteem, quality of life, and stress, the rate of comorbid psychiatric disorders is increased. 30%−50% with FI, FC, and NRFI fulfill the criteria for clinically relevant psychiatric disorders. A special risk group is children with BBD. The concomitant psychiatric disturbances include externalizing, internalizing, and neurodevelopmental disorders. They require assessment and counseling, in severe cases, treatment. They have a negative effect on compliance and outcome if not addressed and left untreated.

Recommendations
Because the comorbidity rate is high, screening for psychological symptoms is recommended for all children in all settings with FI, FC, FNRFI and BBD. In addition to clinical observation, exploration and history, standardized, validated broadband behavioral questionnaires are recommended. If problem items in the clinical range are present, a full child psychiatric or psychological assessment is recommended.