(3-31-15)
- Enuresis
- “functional bladder incontinence”
- The category of enuresis typically excludes any cases with clear biological etiology (structural abnormalities or diseases which would account for failure of urinary control).
- “incontinence” refers to loss of bladder control due to organic factors.
- Children suspected of enuresis should receive medical screening to rule out possible biological factors (sickle cell anemia, juvenile onset diabetes, urinary or bladder infections, etc.)
- Diagnosis of enuresis involves consideration of age and frequency of incidents.
- A minimum age or mental age required.
- A minimum frequency of difficulty required.
- Within the population of children with enuresis it is possible to distinguish different patterns:
- nocturnal, diurnal, mixed patterns
- primary (continuous, chronic) vs.
- secondary (discontinuous, acute) patterns
- The most common presentation seen is a male child who has always wet the bed at night (male, primary pattern, nocturnal enuresis).
- Treatment of enuresis:
- urine alarm (bell-and-pad device)
- medication
- Treatment of enuresis:
- Encopresis
- As with enuresis, considerations of possible organic etiology, pattern of occurrence, pattern of history, sex distribution, minimal age/mental age and frequency requirements are pertinent.
- In contrast to enuresis–an association of fecal soiling with biological problems is more pronounced with cases of perpertied encopresis. A history of constipation in common. Medical screening to rule out physiological problems is important.
- Modal presentation of encopresis is a male child, who has resumed soiling after a period of control of defecation, and who soils during the day (male, secondary, diurnal soiling).
- Treatment of encopresis: careful medical evaluation, treatment of any associated medical difficulties, behavior modification.