Enuresis: Causes, Symptoms And Treatments

Urination is one of the basic functions that our body performs instinctively from birth. In the first years of life, this basic function is part of a process that ultimately allows us to be completely autonomous. This is usually around the fourth or fifth year of life. These kinds of processes teach us to take care of ourselves, but what if your child suffers from enuresis ?

Enuresis is the term we use when someone urinates involuntarily. When a child is potty trained, he gains control over his sphincter.

And one of the things he learns from that is to hold up his pee. Initially, it learns to always pee on a toilet during the day. Finally, the child learns to hold up his urine during the night, which usually takes the longest.

Our gender also determines at what age we become potty trained. Girls normally gain control over their sphincter earlier than boys. Boys are usually between a few months and two to three years behind.

Despite this difference, it is normal to start potty training as early as eighteen months. This usually lasts until the child is between three and five years old.

If after this period a child still does not have full control over his sphincter, then this is considered problematic. There are therefore very few children who are not potty trained after the age of five. If this is the case, it causes quite a lot of inconvenience for both the child and the parents.

What is enuresis?

Officially, enuresis is defined as involuntary urination. This can be day or night and happens when a child is over four or five years old. So we are talking about the phenomenon when children cannot hold their urine and urinate at unfavorable times and places.

At this age, the child should have been toilet trained, unless there is a physical condition.

Nocturnal enuresis is one of the most common problems in children. We speak of this problem when children wet their bed. About ten to twenty percent of all five-year-olds suffer from this nocturnal problem.

Causes of enuresis

Scientists have developed several theories to explain the cause of this problem. So far, however, they have still been fully capable of this. The most accepted theory is therefore that the cause is often multi-causal.

By multi-causal, we mean that there are  several physiological, genetic, and learning factors that contribute to the problem. We look at the interplay between these factors in order to personally identify the cause of the problem for each child.

Physiological Factors

In order to be potty trained, a child must first learn to identify that their bladder is full. Once it has learned this, it should be able to urinate in the right place.

Normally, the bladder is relaxed during the filling phase. The bladder only contracts when it is full. In some cases , however , the muscles in the bladder may be overactive. This causes the bladder to contract involuntarily without actually being full.

This is one of the reasons why children may feel they need to pee and why they still wet the bed at night. Overactivity of the bladder sphincters during the night is the cause in about a third of all cases of nocturnal enuresis.

Genetic Factors

It is now known that in many cases enuresis has a genetic factor. For example, in about 75% of all cases there is an immediate family member with a family history of enuresis.

At the same time, several genes appear to be involved in bedwetting. Yet the results are not completely convincing.

Learning factors

Housetraining is a complex phenomenon that requires us to gradually acquire a set of specific skills:

• Learn to identify when the bladder is full and expanding. Children should be able to recognize that their bladder is full and let others know.
• When awake and their bladder is full, children need to learn to tighten their pelvic floor muscles so that they can hold their pee until they reach the right spot.
• Finally, they must learn to relax their muscles in order to urinate. They must learn to decide for themselves when to empty their bladder and when not to.

A child cannot become fully potty trained without mastering these skills. And if it isn’t able to automatically control its bladder during the day, it won’t be able to at night either.

Symptoms of enuresis

As we mentioned earlier, involuntary urination is the main symptom of enuresis. We speak of enuresis when this happens about twice a week, for a period of at least three consecutive months.

Enuresis can cause quite a lot of discomfort socially and academically. Some children who suffer from nocturnal enuresis may even wake up in the morning with constipation.

Treatments for Enuresis

There are several treatments for enuresis. These range from pharmacological treatments to behavioral treatments. If the problem is treated pharmacologically, the child is usually prescribed imipramine, which is a tricyclic antidepressant.

In recent years, however, many doctors have replaced imipramine with desmopressin, which is an analog of the antidiuretic hormone (vasopressin). It facilitates the reabsorption of water by the kidneys, reducing the amount of urine.

In terms of behavioral treatments, we can say that a consolidated psychological intervention is used. This treatment is based on three basic procedures: the alarm method, toilet training and nighttime toilet training.

So, if one of your children suffers from enuresis, it is best to visit a specialist psychologist. Psychologists believe that behavioral treatment is the most effective. Moreover, you do not have to expose your child to all kinds of drugs that can have unpleasant side effects.

Bibliography:

Comeche Vallejo, I., Vallejo Pareja,  M.A. Manuel de terapia de conducta en la infancia. Dykinson-Psicologia. Madrid, 2012.

Bragado Álvarez, C.  Enuresis infantil. Pyramid. Madrid, 2006.