Enuresis

Enuresis refers to urinary incontinence in children who have surpassed the typical age for bladder control when no underlying lesions or medical conditions justify it.

Children usually acquire an adult pattern of urination control around three to four years of age. It is a very common disorder that can also occur in adolescents.

Based on bladder control, enuresis is classified into:

• Primary enuresis: the child has never regularly controlled urination. This is the most common type.
• Secondary enuresis: there has been a previous period of bladder control lasting at least six to twelve months.

According to when the involuntary urination occurs, the types are:

• Daytime enuresis: the episodes occur during waking hours.
• Nocturnal enuresis: the episodes occur during slow-wave sleep. This is much more common.

Symptoms

The hallmark symptom of enuresis is recurrent involuntary urination. For it to be classified as enuresis, there must be repeated urination at least twice a week for a minimum of three consecutive months in a child aged five years or older or with equivalent developmental level.

Causes

The causes of enuresis can be divided into two subtypes:

• Biological causes: the incontinence has a physiological origin.
• Delayed maturation: often accompanied by delayed speech and motor clumsiness.
• Bladder dysfunction: may involve an overactive bladder that contracts without warning, causing a sudden and strong urge to urinate, or an underactive bladder, with weak contractions that result in infrequent and incomplete emptying.
• Hormonal imbalance: deficiency in the production of antidiuretic hormone (ADH), which normally reduces urine production at night.
• Urinary tract disorders: such as infections, obstructions, or malformations.
• Mental disorders, such as Autism Spectrum Disorder, intellectual disability, etc.
• Sleep apnea: breathing interruptions during sleep can disrupt the brain’s chemical balance and trigger urinary incontinence.
• Constipation: chronic dilation of the rectal ampulla can cause bladder dysfunction.
• Diabetes: diabetes can lead to neurological damage that affects the urinary tract.
• Certain medications, such as lithium, valproic acid, clozapine, or theophylline.
• Neurological disorders, such as spina bifida or vesicoureteral reflux.
• Psychosocial causes:
• Stressful or anxiety-provoking situations: changes in the child’s environment, such as divorce, moving, the birth of a sibling, school trauma, sexual abuse, accidents, hospitalizations, or surgeries, among others. This is one of the main causes of secondary enuresis.
• Family neglect in promoting toilet training.

Risk Factors

Certain conditions increase the likelihood of a child developing enuresis:

• Family history: primary enuresis has a hereditary genetic component.
• Certain mental disorders: it is common in children with neurodevelopmental disorders such as ADHD or ASD.

Complications

Besides being a possible sign of an underlying condition, enuresis by itself can negatively impact a child’s self-esteem and mental health due to the feelings of shame and guilt it may cause. It may also affect their social relationships and academic performance. Additionally, prolonged moisture can lead to rashes on the buttocks and genital area.

Prevention

Certain habits can help reduce involuntary urination:

• Limit consumption of carbonated or sugary drinks, especially in the evening, as they can irritate the bladder and produce excess urine.
• Establish a regular urination routine: every two to three hours during the day and right before bedtime. If needed, wake the child once during the night.
• Increase fiber intake to prevent constipation.
• Address episodes with patience, understanding, and normalcy: punishment or scolding can worsen the problem and cause harm.

Which doctor treats enuresis?

Enuresis is assessed and treated in pediatric and child psychology units.