10 1. Is there a clear diagnosis and which subtype of incontinence is present? An accurate diagnosis is important to start correct treatment. The cornerstone of good diagnostics is primarily an extensive micturition history including frequency, urgency, when and how incontinence occurs, ways of dealing with bladder problems, history of febrile urinary tract infections, and toileting position. Defecation history focused on the Rome IV criteria for constipation is important. 2. Is urotherapy the preferred therapy for the child’s problem? Before starting bladder training, anatomical and neurological causes of incontinence should be excluded. Treatment should first address urinary tract infections (if present), followed by managing the bowel dysfunction (if present) and then daytime incontinence and finally bedwetting. 3. Are the development, maturity, and social environment of the child suitable to undergo this treatment? Assessing psychosocial history is important to judge whether the child has the psychological ability and motivation to understand his/her bladder bowel problems and to understand the rationale of the therapy. Treatment requires a change in the child’s voiding-bowel behaviour and therefore the child should have the discipline and motivation to persist, and the family should be able to support the child during this process. Under the age of 6 years, children do not have sufficient body awareness or the ability for self-reflection and discipline. Therefore, children under the age of 6 years should not receive intensive urotherapy. However, it is more important to explain to the parents how to support their child. Important events such as moving with perhaps a change of school, or the arrival of a new baby may be valid reasons to postpone the start of treatment. Interaction problems within the family can also have a negative impact on treatment results. Behavioural and emotional disorders, such as ADHD, are more often seen in children with functional incontinence. It is essential to take note of this reality. It is recommended to use questionnaires like the Child Behaviour Checklist (CBCL) (see:
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