Enuresis

Refers to the repeated inability to control urination.

Primary enuresis refers to children who have never been successfully trained to control urination.

Secondary enuresis refers to children who have been successfully trained and are continent for at least 6 months but revert to wetting in a response to some sort of stressful situation.

Approximately 15 to 20 percent of 5-year-old children will develop symptoms related to this disorder.

Prevalence of enuresis changes significantly with age: about 33 percent of 5 year-olds, 25 percent of 7 year olds, 15 percent of 9 year olds, 8 percent of 11 year olds, 4 percent of 13 year-olds, and 3 percent of 15 to 17 year-olds.

Types of enuresis include:

Nocturnal enuresis, also known as bed wetting, which is wetting that occurs in the night while asleep, usually presenting with voiding of urine during sleep in a child in whom it is difficult to wake.

Diurnal enuresis refers to wetting that occurs during the day while the child is awake.

Mixed enuresis relates to a combination of nocturnal and diurnal type, with urine is passed during both waking and sleeping hours.

Clinical definition of enuresis is urinary incontinence beyond age of 4 years for daytime and beyond 6 years for nighttime, or loss of continence after three months of dryness.

Enuresis may be accompanied by bladder dysfunction during the day which is termed non-mono symptomatic enuresis.

Day time enuresis also known as urinary incontinence may also be accompanied by bladder dysfunction.

The symptoms of bladder dysfunction include:

Urge incontinence

2. Voiding postponement

3. Stress incontinence

4. Giggling incontinence

Secondary incontinence usually occurs in the context of a n life event that is stressful such as abuse or parental divorce.

Wetting at night is ref2242ed to as

After age 5, wetting at night is often called bedwetting or sleepwetting.

Bedwetting is more common than daytime wetting in boys.

Nighttime enuresis causes are not defined, as young people who experience nighttime wetting tend to be physically and emotionally normal.

Most cases of nocturnal enuresis result from a number of factors including slower physical development, overproduction of urine at night, a lack of ability to recognize bladder filling when asleep, and, in some cases, anxiety.

Nocturnal enuresis is associated with a strong family history of bedwetting, suggesting an inherited factor.

Nocturnal enuresis occurring between the ages of 5 and 10, may be the result of a small bladder capacity, long sleeping periods, and underdevelopment of the body’s brain signaling a full or emptying bladder.

Nocturnal enuresis form of incontinence will fade away as the bladder grows and the natural alarms become operational.

Excessive output of urine during sleep
If the body does not produce enough ADH at night, the making of urine may not be slowed down, leading to the bladder overfilling, and if child does not sense the bladder filling, then wetting will occur.

Anxiety occurring in children ages 2 to 4 might lead to incontinence before the child achieves total bladder control.

Anxiety after age 4 might lead to wetting.

Incontinence itself is an anxiety-causing event.

There is a genetic relationship: if both parents suffered from anuresis, 77% of their children have the same problem, and if only one parent has enuresis 44% of offspring are affected.

Nighttime incontinence may be associated with obstructive sleep apnea, often because of inflamed or enlarged tonsils or adenoids.

A small number children with incontinence have physical problems in the urinary tract: urinary reflux or vesicoureteral reflux, a blocked bladder or urethra may cause the bladder to overfill and leak, nerve damage associated with the birth defect spina bifida, and ectopic ureter.

Daytime incontinence that is not associated with urinary infection or anatomic abnormalities is less common than nighttime incontinence.

Daytime incontinence tends to disappear much earlier than the nighttime process.

Daytime incontinence may be due to an overactive bladder.

An overactive bladder often occurs as a consequence of urinary tract infection and is more common in girls.

A child’s voluntarily holding of urine for prolonged intervals can lead to infrequent voiding.

This can lead to the bladder overfilling and leakage of urine.

Voluntary holding of urine often results in urinary tract infections, leading to an irritable or overactive bladder.

A small bladder capacity, constipation and food containing caffeine, chocolate or artificial coloring can lead to frequent urination.

Many children overcome incontinence without treatment as they grow older.

Incontinence goes down by 15 percent for each year after the age of 5.

Nighttime incontinence may be treated by increasing ADH levels with ab
synthetic version known as desmopressin, or DDAVP.

Desmopressin is approved for use by children.

Relapse rate is as high as 80% on DDAVP withdrawal.

Imipramine, is also used to treat sleepwetting.

Imipramine acts on both the brain and the urinary bladder, but total dryness with either of the medications available is achieved in only about 20 percent of patients.

Incontinence resulting from an overactive bladder, may respond to oxybutynin, that controls muscle spasms and belongs to a class of medications called anticholinergics.

Techniques to decrease daytime incontinence include:

Urinating on a schedule, such as every 2 hours

Avoiding caffeine or other foods or drinks that may contribute to incontinence.

Diurnal enuresis is much less common.

About 60 percent of those suffering with diurnal enuresis are male.

By 11 years of age there are twice as many boys as girls with diurnal enuresis.

Diurnal enuresis varies with social class with more incidences among those with low socioeconomic status.

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