Psychological Disturbances in Children with Elimination Disorders

This post was written by H&W instructor Dawn Sandalcidi, PT, RCMT, BCB-PMD. Dawn's course that she wrote on "Pediatric Incontinence" will be presented in in South Caroline this August.

Dawn Sandalcidi

I will never forget the morning I was called by one of my referring pediatricians to tell me an 11-year-old boy with fecal incontinence hung himself because his siblings ridiculed him. If you ever ask me why I do what I do, I will tell you so that nothing like that would ever happen again.

When we think of pediatric bowel and bladder issues we primarily focus on the physiologic issue itself and treating the underlying pathology. I think it is imperative to teach a child that she/he did not have a leak but their bladder or bowel had a leak. It makes the incident a physiological problem and not a problem of the child.

It is not always apparent how much the child is suffering from issues with self-esteem, embarrassment, internalizing behaviors, externalizing behaviors or oppositional defiant disorders. Dr. Hinman recognized theses issues years ago (1986) and commented that voiding dysfunctions might cause psychological disturbances rather than the reverse being true. Dr. Rushton in 1995 wrote that although a high number of children with enuresis are maladjusted and exhibit measurable behavioral symptoms, only a small percentage have significant underlying psychopathology. In more recent studies by Sureshkumar, 2009; Joinson 2007 it was noted that elevated psychological test scores returned to normal after the urologic problem was cured. Lettgen et al. 2002, Kuhn et al, 2008, van Gontard, 2012 all reported that children with urge incontinence are distressed by their symptoms but the family functioning is intact.

I frequently get testimonials from my patients. I would say the common denominator is the child and/or parental report that the child is “much better adjusted,” “happier”, “come out of his shell”, “more outgoing”, “making friends.” As a side note -- they’re happy they don’t leak anymore.

The International Children’s Continence Society ( is filled with standardization documents that support the work we do to take care of kids with elimination issues. The work we do to take care of these kiddos in not only necessary but also mandatory to avoid these psychological disorders.

Read about Suzanne's Story

To learn more about Dawn's course visit Pediatric Incontinence

Read more about what Dawn does in PT in Motion

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