Enuresis In Children: Causes, Symptoms And Treatments

The excretion of body waste is a basic function that our body performs instinctively from birth. During the first years of life, excretion is part of a process that eventually allows us to become completely autonomous. This evolutionary process usually extends into the fourth or fifth year of life. This learning ends with teaching us the habits of self-care. Enuresis in children means a recurrent inability to avoid urination after the age of five years.

Ring muscle control usually follows a sequence that is common in most children. Among the first bodily functions that children acquire is nocturnal fecal continuity. This means our ability to control bowel movements during sleep. Secondly, children usually achieve fecal continence during the day. Shortly afterwards, children usually achieve daily urinary incontinence. Finally, children achieve nocturnal urinary incontinence, and this usually takes the longest time to learn.

Gender also controls at what age we can control the sphincter. Normally, girls achieve control before boys. In this case, boys develop later than girls, and this delay can vary from a few months to 2 to 3 years. Despite this variation, it is normal for exercise to begin at 18 months of age and continue until the child is between 3 and 5 years old. After this time period, lack of urine or fecal control is considered problematic.

However, there are a few children who, after they are 5 years old, still urinate during the day, or at night. This is difficult for both children and parents.

What is enuresis in children?

Traditionally, enuresis is defined as a progressive and persistent urinary excretion. This secretion occurs during the day, night or during both periods continuously after 4-5 years of age. In other words, the term enuresis refers to repeated, involuntary incontinence problems in inappropriate places, such as in bedding or everyday clothing in children over 5 years of age. At this age, the child should have gained control of the bladder to avoid an organic pathology that increases incontinence.

Nocturnal enuresis is one of the most common problems among children. It refers to urination that occurs during sleep. Between 10 and 20 percent of all 5-year-olds have this problem during the night.

Causes of enuresis in children

Researchers have formulated various hypotheses to explain the origin of enuresis. However, none of the variables that researchers have studied can explain the phenomenon itself. For this reason, the most accepted hypothesis is multi-causal etiology.

The multi-causal etiology refers to the presence of various physiological, maturation, genetic and learning factors. These factors interact with each other to explain the cases of enuresis in children.

Physiological factors

To achieve full control of the bladder, it is necessary for the child to learn to identify that the bladder is full. Once they have realized this, the child should be able to urinate in the right place.

Normally, during the filling phase, the bladder is relaxed. The detrusor muscle, which controls the ability of the bladder to contract, contracts only when the bladder is completely full. In some cases of enuresis, however, the patient shows a strong overactivity in the detrusor muscle. This causes uncontrolled contractions before the bladder is actually full.

This is the reason why children may show a great need to urinate and experience incontinence at night. The overactivity of the detrusor muscle during sleep is the cause of about one-third of nocturnal enuresis cases.

Genetic factors

It is a known fact that enuresis is to some extent a hereditary disorder. In about 75% of all cases of enuresis, there is a family history of the disease.

Similarly, several genes have been identified that appear to be involved in nocturnal enuresis. Nevertheless, the results are not entirely unanimous.

Learned factors

The voluntary control of urination is a complex phenomenon that requires the success of a series of specific skills:

• Ability to detect when the bladder is full. The child must be able to realize that the bladder is full and be able to communicate it to others.
• To wake up from the need, and with a full bladder learn to contract the pelvic muscles to avoid urination until you reach the right place.

• A relaxation of the muscles to start urinating. Control over urination. To be able to stop and start emptying the bladder.

If the sequence is not learned properly, it will not be automated. If it is not automated, the process is not transferred to sleep to achieve nocturnal control of urination.

Symptoms of enuresis in children

As we explained, the main symptom of enuresis is urination, whether it is unintentional or intentional. This must occur at a frequency of two events per week for a period of at least three consecutive months to be classified as enuresis.

Enuresis causes clinically significant social discomfort. Some children with nocturnal enuresis may wake up with constipation.

Treatment of enuresis

There are several treatments for enuresis ranging from pharmacological treatment to behavioral therapy. In pharmacological treatment, one of the most widely used drugs has historically been imipramine, a tricyclic antidepressant.

In recent years, imipramine has been replaced by desmopressin, which is comparable to the antidiuretic hormone vasopressin. It facilitates the kidneys’ reabsorption of water so that urine volume is reduced.

When it comes to behavioral therapy, we can categorize this as a consolidated psychological intervention. This treatment stems from three basic procedures: attention, urinary retention training and exercise to avoid bedwetting.

So if any of your children suffer from enuresis, it is best to visit a psychologist who specializes in the field. Psychologists believe that behavioral therapy is most effective and thus one can avoid the side effects of drugs.