Bedwetting (Nocturnal Enuresis) Bedwetting (Nocturnal Enuresis) Orina en la cama (enuresis nocturna) What Is Enuresis? Alex falls into an extremely deep sleep almost every night. He sleeps so soundly that you could set off a fire alarm next to his bed and he probably wouldn't hear it. Even having to pee doesn't wake him up, so Alex sometimes wets the bed. He feels embarrassed, but isn't alone — this problem affects about 1–2 out of every 100 teens. The medical name for not being able to control your pee is enuresis (pronounced: en-yuh-REE-sis). Sometimes enuresis is also called involuntary urination. Nocturnal enuresis is involuntary urination that happens at night while sleeping, after the age when a person should be able to control his or her bladder. (Involuntary urination that happens during the day is known as diurnal enuresis.) There are two kinds of enuresis: primary and secondary.

Someone with primary nocturnal enuresis has wet the bed since he or she was a baby (primary nocturnal enuresis is the most common form). Secondary enuresis is a condition that develops at least 6 months — or even several years — after a person has learned to control his or her bladder. The bladder is a muscular receptacle, or holding container, for pee (urine). It expands (gets bigger) as urine enters and then contracts (gets smaller) to push the urine out. In a person with normal bladder control, nerves in the bladder wall send a message to the brain when the bladder is full; the brain then sends a message back to the bladder to keep it from automatically emptying until the person is ready to go to the bathroom. But people with nocturnal enuresis have a problem that causes them to pee involuntarily at night. continue What Causes Enuresis? Doctors don't always know the exact cause of nocturnal enuresis. They do have some theories, though, on what may contribute to someone developing the condition: Hormonal problems. A hormone called antidiuretic hormone, or ADH, causes the body to produce less urine at night.

But some people's bodies don't make enough ADH, which means their bodies may produce too much urine while they're sleeping. Bladder problems. In some people with enuresis, too many muscle spasms can prevent the bladder from holding a normal amount of urine. Some teens and adults also have relatively small bladders that can't hold a large volume of urine. Genetics. Teens with enuresis often have a parent who had the same problem at about the same age. Scientists have identified specific genes that cause enuresis. Sleep problems. Some teens may sleep so deeply that they don't wake up when they need to pee. Caffeine. Using caffeine causes a person to urinate (pee) more. Medical conditions. Medical conditions that can trigger secondary enuresis include diabetes , urinary tract abnormalities (problems with the structure of a person's urinary tract), constipation, and urinary tract infections (UTIs) . Spinal cord trauma, such as severe stretching of the spinal cord resulting from a fall, sports injury, auto accident, or other event may also play a role in enuresis, although this is rare. Psychological problems. Some experts believe that stress can be associated with enuresis.

It's not uncommon to feel stressed out during the teenage years, and things such as divorce, the death of a friend or family member, a move to a new town and adapting to a new school and social environment, or family tension can feel overwhelming. Doctors don't know exactly why, but more than twice as many guys as girls have enuresis. It is often seen in combination with ADHD . How Is Enuresis Diagnosed? If you're having trouble controlling your urine at night, talk to your doctor to learn more about nocturnal enuresis and to rule out the possibility of a medical problem. In addition to doing a physical examination, the doctor will ask you about any concerns and symptoms you have, your past health, your family's health, any medications you're taking, any allergies you may have, and other issues. This is called the medical history. He or she may ask about sleep patterns, bowel habits, and urinary symptoms (such as an urge to pee a lot or pain or burning when you pee). Your doctor may also discuss any stressful situations that could be contributing to the problem. The initial exam will probably include a urinalysis and urine culture. In these tests, urine is examined for signs of disease.

Most of the time in people with nocturnal enuresis, these test results come back completely normal. previous continue How Is It Treated? Doctors can do several things to treat bedwetting, depending on what's causing it. If an illness is responsible, which is not very common, it will be treated. If the history and physical examination do not suggest a specific medical problem and the urine tests are negative, several behavioral approaches can be used for treatment: Manage what you eat and drink before bed. People with nocturnal enuresis can take some basic steps to prevent an overly full bladder by decreasing the amount of fluids they drink before going to bed. You can reduce the chances that you'll wet the bed by going to the toilet just before bedtime. It may help to avoid eating certain foods in the evening: Foods that can irritate the bladder include coffee, tea, chocolate, and sodas or other carbonated beverages containing caffeine. Imagine yourself dry. Using a technique called positive imagery, where you think about waking up dry before you go to sleep, can help some people stop bedwetting. Some people find that rewarding themselves for waking up dry also works. Use bedwetting alarms.

Doctors and nurses sometimes prescribe bedwetting alarms to treat teens with enuresis. According to the National Kidney Foundation, 50% to 70% of cases of enuresis respond to treatment with these moisture alarms. With these alarms, a bell or buzzer goes off when a person begins to wet the bed. Then, you can quickly turn the alarm off, go to the toilet, and go back to sleep without wetting the bed too much. Don't get discouraged if the alarm doesn't help you stop wetting the bed immediately, though. It can take many weeks for the body to unlearn something it's been doing for years. Eventually, you can train yourself to get up before the alarm goes off or to hold your urine until morning. People who sleep very deeply may need to rely on a parent or other family member to wake them up if they don't hear the alarm. The key to bedwetting alarms is waking up quickly — the sooner a person wakes up, the more effective the behavior modification for telling the brain to wake up or send the bladder signals to hold the urine until the morning.

Sometimes doctors treat enuresis with medication — although this is not usually the first course of action because no medicine has been proved to cure bedwetting permanently, and the problem usually returns when the medicine is stopped. Doctors sometimes prescribe a manmade form of ADH to decrease urine buildup during the night. Other medications relax the bladder, allowing it to hold more pee. If you're worried about enuresis, the best thing to do is talk to your doctor for ideas on how to cope with it. Your mom or dad can also give you tips on how to cope, especially if he or she had the problem during adolescence. The good news is that it's likely that bedwetting will go away on its own. In fact, 15 out of 100 kids who wet the bed will stop every year without any treatment at all.

enuresis | pathology | Britannica.com pathology human body Enuresis, elimination disorder characterized by four factors: the repeated voluntary or involuntary voiding of urine during the day or night into bedding or clothing; two or more occurrences per month for a child between the ages of five and six (one or more for older children); chronological age of at least five, mental age of at least four; and the absence of a causative physical disorder. Enuresis may additionally be classified as primary (when urinary continence has never been achieved), secondary (when continence was achieved for at least one year and then lost), nocturnal (occurring only during sleep), or diurnal (occurring during waking hours). The most prevalent form is nocturnal enuresis (also called bed-wetting and usually of the primary type), and the disorder occurs more often among boys than girls. Roughly 1 percent of children continue to be affected by this disorder until the age of 18. A number of genetic, social, physical, and psychological factors may play a role in the disorder. Considerable evidence indicates that enuretic individuals often are members of families in which parents or siblings also have been enuretic.

Stressful life events, poor toilet training, and chronic social disadvantage are among the social factors that have been found to increase the prevalence of enuresis. No specific physical factor has been pinpointed, but slight delay in maturation and limited functional bladder capacity have been noted in some enuretic children. While some enuretic children have emotional or behavioral disorders, no causal relationship can be established with certainty. Treatment includes education and reassurance of parents and child, behavioral-conditional therapy, and the use of an alarm to awaken the child when urination is begun. The latter treatment is often effective, as it allows the child with nocturnal enuresis to associate the presence of a full bladder with the need to awaken and go to the bathroom. Treatment by drugs is usually a last resort. Vasopressin (also called antidiuretic hormone), taken as a nasal spray, is effective at decreasing the amount of urine produced at night. The drug imipramine has had some success in increasing the bladder’s capacity to hold urine, but no single method of treatment has been entirely successful.

Learn More in these related articles: Enuresis Enuresis If you'd like to be informed about updates to this site, click here pdf version of this page (162kb) If you've come to this page directly via a search engine, please note this essay is mainly for homeopaths and students of homeopathy, so assumes a certain level of understanding of homeopathic concepts and terminology. When I was studying homeopathy at college (1994-1998) we were encouraged to exchange returned assignments in order to benefit from each other's perspectives on the subject. This essay is offered in that spirit. It was written for a specific assignment and although there might be additional insights I would add now, it's presented here as I wrote it originally. This work is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported License Human Science | Enuresis Assignment: Look at possible medical causes for enuresis and know about investigations and possible orthodox treatment involved. Look at 6-8 remedies with particular association with this condition. ‘The unconscious or involuntary passage of urine.’ (Blacks, 1992.

p199) ‘Enuresis is a term which is reserved for incontinence in children. It is the involuntary passing of urine at night when asleep. The existence of incontinence during the day suggests a kidney or bladder condition. It is mainly a disorder found in boys and affects 10% of boys aged 4-11 years. There are estimated to be 500,000 cases in Britain between the age of 6 and 16. As a group they also have signs of decreased muscle tone, co-ordination problems and EEG abnormalities. It is considered to be a sleep disorder and so is treated by the antidepressant imipramine. This is an attempt to alter depth of sleep and has little effect. There is the added danger of poisoning by overdose. ‘Less harmful are behavioural methods such as an alarm bell. This is connected to a mat under the sheet so that the bell sounds if the child wets the bed. Intranasal desmopressin, antidiuretic hormone, is used in some cases although the manipulation of pituitary hormones to treat bed-wetting seems excessive. Enuresis is notoriously difficult to treat and is frequently related to psychological factors.

It may be necessary to address the family as a whole as well as the individual child.’ (Gascoigne, 1995. p179) Nocturnal Enuresis ‘The involuntary passage of urine during sleep. It is a condition predominantly of childhood. In a small minority of cases it is due to some organic cause such as infection of the genito-urinary tract, but in the vast majority of cases it is due to inadequate or improper training of the child or psychological ill-health. Traditionally it is said to be associated with threadworms, but there is little, if any, evidence to support this tradition. ‘Before deciding that a child is suffering from nocturnal enuresis, it is necessary to remember that the age at which a child achieves full control of bladder function varies considerably. Such control is usually achieved in the second year, but more commonly in the third year of life, and there are some children who do not normally achieve such control until the fourth, or even fifth, year. ‘It is a difficult condition to cure in the absence of an organic cause. If there should be an organic cause, treatment consists of its eradication.

In the absence of such a cause, treatment consists essentially of reassurance and firm but kindly and understanding training. In quite a number of cases the use of a buzzer alarm which wakens the child should he start passing water is helpful provided that it is backed up by psychological support from the parents and the family doctor.’ (Blacks, 1992. p412) ‘Nocturnal enuresis is a normal occurrence in young children but persists in as many as 5% by 10 years of age. In the absence of urinary-tract infection simple measures such as bladder training or the use of an alarm system may be successful. Drug therapy is not appropriate for children under 7 years of age and should be reserved for when alternative measures have failed preferably on a short-term basis to cover periods away from home. The possible side-effects and the toxicity of these drugs if taken in overdose should be borne in mind when they are prescribed.

‘Desmopressin, an analogue of vasopressin [antidiuretic hormone, ADH], is used for nocturnal enuresis; particular care is needed to avoid fluid overload and treatment should not be continued for longer than 3 months without stopping for a week for full re-assessment. ‘Tricyclics such as amitriptyline, imipramine, and less often nortriptyline are also used but behaviour disturbances may occur and relapse is common after withdrawal. Treatment should not normally exceed 3 months unless a full physical examination (including ECG) is given and the child is fully re-assessed.’ (British National Formulary, no 33 (March 1997) p351) Organic Causes of Bladder Dysfunction Urinary incontinence is often a symptom resulting from confusion and immobility experienced in acute illness. Other chronic causes may relate to damage to the cerebral cortex (cerebrovascular disease, Alzheimer’s, Parkinson’s), spinal cord damage (MS, trauma or tumour), or damage to afferent parasympathetic fibres (diabetic autonomic neuropathy).

Local causes include pressure on the bladder from fæcal impaction, stress incontinence due to pelvic floor weakness in women, prostatic obstruction, and post-menopausal atrophic changes in the vagina, urethral and trigonal mucosa. Other causes include drugs such as diuretics, poor mobility, anxiety or attention-seeking behaviour. Important considerations are duration and timing of incontinence, associated urinary symptoms and drug treatment. Examination of abdomen, central nervous system, rectum, perineum, vulva and vagina are necessary to determine existence of any organic cause. Urine cultures are taken. Pelvic ultrasound may identify chronic urinary retention; catheterisation and cystometrography provides information about dynamic filling pressures within the bladder. Cystoscopy and cinefluoroscopy may be used where the diagnosis is otherwise unclear.

Patterns of Neurogenic Bladder Dysfunction Atonic bladder Cause: Damage to sacral segments of conus medullaris Damage to sacral roots/nerves and pelvic nerves Results: Loss of detrusor contraction Difficulty initiating micturation Distension of bladder, overflow incontinence Hypertonic bladder Cause: Spinal cord damage involving pyramidal tracts above conus medullaris Frontal lobe lesions Results: Urgency and urge incontinence Bladder/sphincter incoordination Post-central — loss of awareness of bladder fullness, incontinence Pre-central — difficulty initiating micturation Frontal — inappropriate micturation, loss of social control (Edwards et al, 1995. p1030) Treatment of Urinary Incontinence ‘The mainstay of treatment is toilet training in which patients are encouraged to anticipate episodes of incontinence by regular emptying of their bladder. Practical measures such as modifying the dose of a diuretic or facilitating access to the lavatory may also be effective.’ (Edwards et al, 1995. p1121) Physical obstructive causes (fæcal impaction, prostatitis) are generally treated by removal of the obstruction.

Bladder relaxants such as oxybutinin are used in cases featuring hypertonic bladder. Oestrogen creams are used in atrophic vaginitis. Exercises and possibly reconstructive surgery are the treatments for pelvic floor weakness. If all preventative and management treatment fails, catheters and incontinence pads are used. (See also extract from BNF under Nocturnal Enuresis above.) Bell & Pad Training ‘This is used in the treatment of enuresis. A special pad is placed under the patient’s bed-sheet. It contains an electric circuit which is completed when wetted by urine, thereby sounding an alarm bell which wakes the patient. Micturation is interrupted and the patient gets up to complete emptying his or her bladder. After repeated training the patient learns to respond to sensations of bladder distension and wakens before micturation occurs.’ (Edwards et al, 1995. p984) Esoteric View In an attempt to understand the ‘meaning’ of nocturnal enuresis from a more esoteric point of view, I looked at several publications which are usually quite helpful in coming to an understanding of the dynamics involved. Few of them dealt with the problem directly.

Dethlefson does so, but perhaps reveals more about himself than the condition in the process. ‘Illness and death are regularly used to submit the world to extortion … it is quite easy to detect the theme of ‘symptoms as expressions of power’ in the particular case of bed-wetting. If a child spends all day under such strong pressures (whether from parents of from school) that it can neither let go nor express its own needs, nocturnal bed-wetting solves several problems at once: it provides the chance to let go in response to the pressures being experienced, and at the same time it offers the child the opportunity to condemn its otherwise all-powerful parents to utter helplessness. By way of this particular symptom, in fact, the child is able to return in safely disguised form all the pressure that it is put under during the day. At the same time we should not overlook the link between bed-wetting and crying. Both of them serve to unload and release inner pressures by way of ‘letting go’. We could thus describe bed-wetting as a kind of ‘lower level crying’. (Dethlefson & Dahlke, 1990.

p180-181) I find, as with many other areas he covers, that while there appears to be some element of truth in his analysis, its judgmental tones are obstructive and it does not seem to reflect the whole picture. Page does not mention the problem specifically, but deals with the diathesis in her chapter on base chakra imbalances: the polarity between control and insecurity manifested by individuals who have not fully inhabited their bodies or committed themselves to life on earth. The lack of sufficient soul pressure in the area of the base chakra leads to problems — ‘Whether the insecurity is consciously revealed or not, when there is poor control on matter by spirit, diseases emerge which relate to undisciplined energy in the base chakra. These include panic attacks with palpitations, hyperventilation, frequency of micturation (passing water), regular trips to the toilet to open the bowels and muscle spasms. The physical body is out of control.’ (Page, 1994. p119-120) The anthroposophists have a similar slant though from a different model.

The kidney is regarded as the organ which impregnates food substances absorbed by the body with astral forces, connecting with the astral body and its supporting element, air. Urine secretion varies with atmospheric (air) pressure and also in response to stress, bodily reactions of which are moderated through the function of the adrenal glands — flight or fright responses effect urine release. Remedies The following are remedies listed in the Complete Repertory under Bladder, Urination, involuntary, together with Bladder, Urination, involuntary, night, incontinence in bed, plus remedies listed in various materia medica and articles (in red font) associated with enuresis. Where these latter remedies do not appear in the Complete in the rubrics above, the publications containing the reference(s) to the remedies are listed (see Bibliography). Abrom-aug (G) Stry (B, C, Hl, Hu) Alet Syph (Bo, HR, J, P) Alumn Kali-i (Bu, C, H, Kn) Ox-ac BENZOIC ACID Affinities: URINARY ORGANS (kidneys, bladder), JOINTS. Heart. Bowels. Left side. Left side then right.

Right side then left. Mind: Dwells upon disagreeable occurrences, unpleasant things. 'If he saw anyone who was deformed it made him shudder.' (Vermeulen, 1996. p136) Hurry followed by fear. Sensitive to noise. Frequent omission of words in writing. Desires to be carried. Children will not be laid down. Generals: Alternating states. Inflammatory states of tongue, throat, tonsils, stomach and rheumatic manifestations. 'It is always characteristic of benzoic acid when the pains wander from one place to another when they vanish from the joints and extremities, then involve internal organs and reversely when the symptoms reappear in the joints with the improvement of the cardiac complaints, and when the urine periodically alters in regard to its amount, colour, specific gravity and odour in relation to the general symptoms of sleep, psyche, headache, and the urine is striking through its odour.' (Leeser, 1935. p690) Urine: Urine of a very repulsive odour, of a changeable colour. Strong hot dark brown urine; foul, ammoniacal or odour of horse's urine, immediately on voiding.

Enuresis nocturna with penetrating urinous odour. Sheets usually stained brown. CAUSTICUM NERVES (motor, sensory). MUSCLES (BLADDER, LARYNX, limbs). Respiration. Skin. Right side; face. Left side. Mind: Weeping from sympathy with others. Suffer with others. Ailments from grief. Internal suffering (kept in). Suffer from injustice in society. Immovable points of view. Indifference to dictates of conscience. Fear something will happen. Sensitive to authority. Fear of dark. Stammering. Anarchistic. Idealistic. Generals: Chilly, < cold air, cold dry weather. < wet weather, bathing. Burning pains, rawness, soreness. Local paralytic affections. Sensation as if muscles and tendons too short. Gradual paralysis on all levels. > sips of cold water. Craves smoked food. Urine: 'Involuntary urination, particularly in children. This may take place either at night when they are asleep or in the day while awake.

In nocturnal enuresis, the emission of urine takes place during the first part of the night, after they have hardly fallen asleep. At times this takes place even before they have slept and it comes on so easily that they are hardly conscious of it. All sensations are wanting, and they only make certain of it by feeling with their hands and finding themselves in a pool of urine. Then again, due to paralysis of the sphincter muscles, we have involuntary urination while coughing, sneezing and blowing the nose.' (Choudhuri) EQUISETUM HYEMALE GENITO-URINARY TRACT. Right side. Mind: Disposed to frown. Angry. Dreams of crowds. Abnormalities that remain because he has made a habit of it (eg biting nails). Generals: Disturbed sleep due to tiresome dreams. Worse at close of urination. Urine: Aching, full, tender bladder not relieved by urination. Constant desire to urinate; passes large quantities of clear, light-coloured urine without relief. Nocturnal enuresis, especially in first sleep, with irritable bladder. Dribbling of urine. Urine cloudy with great amount of mucous on standing.

Excessive burning in urethra while urinating. Haematuria. 'This remedy is sometimes successful in cases which are not relieved by Cantharis ... there are larger quantities of urine discharged than with Canth, which has characteristically very small amounts, but often repeated, even but a few drops at a time. Equisetum, like Chimaphila, sometimes shows excess of mucous, and it is also very useful in enuresis' (Nash, 1913. p422) KREOSOTUM MUCOUS MEMBRANES (DIGESTIVE TRACT; gums; stomach; abdomen; female genitals; uterus). BLOOD. Teeth. LEFT SIDE. Mind: Fear of coition, fear and dreams of rape. Many problems around menstrual period. Every emotion attended with throbbing. Sadness and weeping from music. Generals: Excitement, restlessness, headache around menstrual period. Chilly. Corrosive, hot, foul discharges. Ailments from too rapid growth. Profuse haemorrhages from small wounds. Difficult dentition. Child screams the whole night; won't sleep unless caressed and fondled all the time.

Urine: 'It is one of our grand remedies for incontinence of urine. The urging is so great that the patient cannot get out of bed at night quick enough. The urine is chestnut brown, fœtid, alkaline and deposits a white sediment. It is a first class remedy for nocturnal enuresis of children. They wet the bed during the first sleep from which they are roused with difficulty. They frequently dream that they are passing urine in the proper place, but they wake up, also, to find out that it has been done in the most incompatible manner and in the most improper place.' (Choudhuri) 'Nocturnal enuresis from too profound sleep. Child cannot be awakened when taken up.' (Clarke, 1900. Vol II p178) LAC CANINUM NERVES. THROAT. Female organs. Breasts. ALTERNATING SIDES. Mind: Great lack of self confidence. Forsaken feeling. Self contempt (delusions, dirty, falling to pieces, being looked at, loathing of oneself, fear of failure). Hypersensitive amounting to hysteria. Forgetful and absent-minded.

Aggression (cursing, malicious, rudeness, rage, hateful, scolding at slightest provocation). Many fears from strong imagination. Constant desire to wash hands. Aetiology disturbance in mother-child relationship. Sensation as if floating in air. Generals: Warm-blooded. Alternating sides. Desire for pungent things (pepper, mustard) and salt. > cold applications. Ravenous appetite. Glistening, shining parts (throat, chancres, ulcers). Urine: 'Nocturnal enuresis especially in those children who have grown up to adolescence and kept this habit. I have learned to always refer to Lac Caninum in those cases and see if I could not get other corroborative symptoms. It is amazing how many of them you can get, and what fine work the remedy does.' (Dixon, Homeopathic Recorder) 'Nocturnal enuresis (specific). Bladder seems full after urination.' (Phatak) 'Urine bright coloured. Slight difficulty in urinating, but at times very profuse and light-coloured. Desire to urinate often, with difficulty. Urine unusually frequent and dark.

Constant and urgent inclination to urinate in large quantities, though not at all thirsty; urine highly coloured; next day the same urgent inclination, but urine was scanty, very turbid, and left a reddish sediment.' (Swan) PLANTAGO MAJOR NERVES. Teeth, ears, spleen. Emmissions. Worms. Wounds. Mind: Irritable, morose disposition. Great mental prostration, < mental exertion, causing rapid respiration and anxiety. Restlessness, pacing back and forwards. Intolerant of contradiction. Dullness > walking in open air. Hurry, desire to do several things at once. Undertakes many things, perseveres in nothing. Generals: Considerable clinical reputation in earache, toothache, enuresis. Neuralgia of ears, teeth, face. Sudden boring pains < right side. Sharp darting pains in left side. Shifting pains. Restlessness especially of lower extremities. < sitting, > moving about. Frequent attacks of sudden sneezing with profuse watery bland coryza. Tongue white coated, breath putrid. Eructations tasting of sulphur. Thirst. Grinding of teeth during sleep.

Weariness and prostration with desire to yawn and stretch. Abdominal colic > eating. Urine: Profuse flow. Nocturnal enuresis, especially where lax condition of sphincter vesicae. Frequent emission of large quantities of pale urine, hot, scalding. Profuse, colourless urine, depositing white sediment < midnight to morning. 'It is especially applicable to the nocturnal enuresis of children, particularly when depending on laxity of sphincter vesicae. In most of these cases the children secrete a large quantity of pale, watery urine, and though great pains are taken to have the bladder thoroughly emptied before retiring, yet the pressure on the weak sphincter will cause its escape before morning. It is of no use when enuresis is due to paralysis of the sphincter.' (Choudhuri) TUBERCULINUM Enuresis Enuresis II.

Definition: Enuresis (DSM-IV Classification) Repeated voiding of urine into bed or clothes Involuntary or intentional Clinically Significant criteria (one of the following) Twice weekly for at least 3 consecutive weeks Significant distress Age 5 years or older Secondary cause not present No history of urinary continence for more than 6 months Secondary Enuresis (20%) Enuresis recurs after 6 months of urinary continence Typically associated with new psychosocial stressors or medical or behavioral condition Monosymptomatic or nonmonosymptomatic Nighttime bed wetting without other symptoms Non-monosymptomatic Enuresis (associated with more significant abnormality) Daytime lower urinary tract symptoms (e.g. urgency, frequency, incomplete emptying) or Holding maneuvers (e.g. leg crossing) Timing IV. Epidemiology: Prevalence of Enuresis Age 2 years: 82% Age 12 years: Boys: 8%; Girls 4% Age 18 years: Boys: 1%: Girls rare V.

Pathophysiology Enuresis Prevalence decreases with age " Bladder full" signal does not yet work Inability to awaken in response to the stimulus of a full Bladder Other predisposing factors Strong association with Family History Gene markers on Chromosome 5, 12, 13 and 22 Both parents with Enuresis: 77% chance of Enuresis One parent with Enuresis: 44% chance of Enuresis Relative Risk if Father with Enuresis: 7.1 Relative Risk if mother with Enuresis: 5.2 VI.

Causes: Secondary (3%) Bladder Dysfunction or unstable Bladder (3-5%) Medically treatable Fecal Impaction or Constipation often with comorbid Encopresis and treatment resistance (33-75% of cases) Overactive Bladder or dyfunctional voiding (<41% of cases) Surgically treatable Bladder calculus or foreign body Obstructive Sleep Apnea secondary to large adenoids (10 to 54% of cases) Psychiatric illness (in only 20%) More common in enuretic girls Suggested by Enuresis both night and day More likely if Enuresis persists in older child Regressive Enuresis (occurs after being dry) Associated with stressful environmental event VII. History Consider a two week voiding diary Does child meet DSM-IV criteria for Enuresis above? Has the child ever been dry for a 6 month period? (primary or secondary) Is there daytime Enuresis? (complicated Enuresis) Characterize the Enuresis How many days per week? How many times per night? What time of night does Enuresis occur?

Constipation with hard stools at a frequency of <4 times per week Functional Bladder disorder or neurogenic Bladder signs Frequent urination with voids >7 per day Urine urgency Withholding urine until last minute Wets more than once nightly Small volumes from incomplete emptying Dribbling, straining to obtain even a weak urine stream Nocturnal polyuria Enuresis on only a few nights per week Voids large volumes when Enuresis occurs Soaked absorbant underpants or voids large first-morning void despite Enuresis? Excessive water intake prior to bed? Weight loss associated with polydipsia and polyuria ( Diabetes Mellitus )? Other related history Neurologic disorders (motor disorders, Learning Disorder s, developmental delay)?

Genitourinary surgeries Evaluate for Tonsillar Hypertrophy (and consider enlarged adenoids) suggestive of pediatric Sleep Apnea Abdominal and flank exam Costovertebral angle tenderness (CVA tenderness) Abdominal masses Excoriations at the perineum or perianal region Prepubertal vulvovaginitis Fecal Impaction or signs of soiling ( Constipation , Encopresis ) Decreased sphincter tone (may be comorbid with neurogenic Bladder ) Back exam Dimple, hair tuft, Lipoma or other skin findings in the midline superior to the gluteal cleft ( Spinal Dysraphism signs) Gait Evaluation for neurologic deficits Lower limb motor weakness or reflex abnormality IX. Labs Basic metabolic panel including Renal Function X. Imaging Indicated for suspected Spinal Dysraphism XI. Management: Referral Indications Prior pelvic surgery Neurologic disorders (e.g.

neurogenic Bladder ) Failure to respond after age 7 years old to adequate trial of bed alarm and Desmopressin Psychiatric disorder Reassure parents with age-related norms Counsel family regarding conflict surrounding Enuresis Assess for organic causes (see above) Complete history and physical with Urinalysis No further evaluation necessary if normal results Treat reversible underlying causes Obtain Consultation for complicated secondary causes See referral indications above Most effective treatment for Nocturnal Enuresis Visualization techniques Limit fluids 1 hour before bedtime Scheduled awakening during night to void Some experts do not recommend Positive reinforcement system Charts the child's progress of dry nights Given stickers on calendar or points per dry night Enlist support and cooperation of child Older children launder their own soiled clothes Should not be punishment Allows child's participation and responsibility Avoid harmful measures Waking child repeatedly during the night to void Interferes with sleep Punishing or shaming the child for wetting the bed Intimidating the child or lowering his self esteem Postponing the child's bedtime to decrease Bedwetting XIV.

Management: Pharmacologic Therapies Try to avoid medications if possible Medications are only effective briefly Drug tolerance is common Symptoms are exacerbated after drug is discontinued Adverse effects are common If used, avoid in under age 6 years Medications: Primary Nocturnal Enuresis Typical dose: 25 mg nightly Not first line due to cardiac arrhythmia risk As effective as Desmopressin Restrict fluid intake 1 hour before taking dDAVP Nasal form is no longer approved for Enuresis due to Hyponatremia (water Intoxication ) Can also occur with oral form, but less commonly For intermittent use on overnights or summer camp Effective in children with nocturnal polyuria (but high relapse rate) Not effective in low nighttime urine output or small Bladder capacity Consider in combination with dDAVP XV. Course Annual resolution rate of Nocturnal Enuresis: 15% XVI.

References Wan (1997) Pediatr Clin North Am 44:1117-31 [PubMed] Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Enuresis." Click on the image (or right click) to open the source website in a new browser window. Search Bing for all related images Related Studies (from Trip Database) Open in New Window Ontology: Enuresis (C0014394) Definition (MSHCZE) Pomočování, mimovolní močení vyskytující se po 4. roku věku. Vyskytuje se nejč. v noci (enuresis nocturna), méně často ve dne (enuresis diurna). Dítě popř. i dospělý močí ve spánku i ve věku, kdy již normálně ovládá svůj močový měchýř. (cit.

Velký lékařský slovník online, 2013 ) Definition (NCI) An elimination disorder characterized by urinary incontinence, whether involuntary or intentional, which is not due to a medical condition and which occurs at or beyond an age at which continence is expected (usually 5 years). Definition (CSP) inability to control the flow of urine and involuntary urination. Definition (MSH) Involuntary discharge of URINE after expected age of completed development of urinary control. This can happen during the daytime (DIURNAL ENURESIS) while one is awake or during sleep (NOCTURNAL ENURESIS). Enuresis can be in children or in adults (as persistent primary enuresis and secondary adult-onset enuresis).

Concepts 8009008 English Enuresis, ENURESIS, [D]Enuresis (context-dependent category), [D]Enuresis NOS (context-dependent category), [D]Enuresis NOS, Enuresis [D], enuresis (diagnosis), enuresis, Enuresis [Disease/Finding], Enuresis NOS, [D]Enuresis, Enuresis (& [bedwetting]) (disorder), Enuresis (& [bedwetting]), Enuresis [D] (situation), Enuresis (finding), [D]Enuresis NOS (situation), [D]Enuresis (situation), Enuresis, NOS, Enuresis (finding) [Ambiguous], Enuresis [D] (finding) French ENURESE, Enuresia, Enurese Spanish ENURESIS, [D]enuresis, SAI (categoría dependiente del contexto), [D]enuresis (categoría dependiente del contexto), enuresis (hallazgo), enuresis, [D]enuresis (situación), [D]

enuresis, [D]enuresis, SAI, [D]enuresis, SAI (situación), enuresis (concepto no activo), enuresis [D] (hallazgo), enuresis [D], Enuresis German NEDERZHANIE MOCHI NOCHNOE, ENUREZ, НЕДЕРЖАНИЕ МОЧИ НОЧНОЕ, ЭНУРЕЗ Croatian Psykogen enurese, Enurese, Ikke-organisk enurese, Ufrivillig urinlating, Funksjonell enurese Dutch Derived from the NIH UMLS ( Unified Medical Language System ) Ontology: Bedwetting (C0270327) Definition (MEDLINEPLUS) Many children wet the bed until they are 5 or even older.

A child's bladder might be too small. Or the amount of urine produced overnight can be more than the bladder can hold. Some children sleep too deeply or take longer to learn bladder control. Children should not be punished for wetting the bed. They don't do it on purpose, and most outgrow it. Until then, bed-wetting alarms, bladder training and medicines might help. Definition (SNOMEDCT_US) Intermittent incontinence of urine while sleeping, regardless of whether intermittent daytime urinary incontinence is also present or not. Definition (SCTSPA) Incontinencia intermitente de orina durante el sueño, independientemente de la presencia de incontinencia urinaria en horas del día. Definition (MSH) Involuntary discharge of URINE during sleep at night after expected age of completed development of urinary control.

Concepts 68191002 English NOCTURNAL ENURESIS, Bedwetting, Nocturnal enuresis (disorder), Nocturnal enuresis (finding), Enuresis, Nocturnal, Incontinence, Nighttime Urinary, Nighttime Urinary Incontinence, Nocturnal Enuresis, Urinary Incontinence, Nighttime, ENURESIS, NOCTURNAL, 1, BEDWETTING, ENUR1, Nocturn incontinence of urine, Nocturnal only enuresis, unable to restrain urination at night while asleep (symptom), unable to restrain urination at night while asleep, enuresis, Noct.

enuresis, Nocturnal Enuresis [Disease/Finding], bed wet, wetting bed, bed wetting, bed wets, wets bed, bedwetting/enuresis, enuresis bedwetting, bedwetting, bed-wetting, wet bed, bedwetting enuresis, Enuresis, enuresis nocturnal, nocturnal enuresis, nocturnal enuresis (diagnosis), Bed wetting, Nocturnal enuresis, Wets bed, Nocturnal incontinence of urine, Bedwetting/enuresis, enuresis; nocturnal, nocturnal; enuresis, Bed-wetting Spanish enuresis nocturna (hallazgo), Enuresis nocturna, Mojar la cama, Enuresis Nocturna, Mojar la Cama, enuresis nocturna (trastorno), moja la cama, incontinencia nocturna, Orinarse durante el Sueño, Micción Nocturna Involuntaria, Orinarse en la Cama, Incontinencia Urinaria Nocturna, Micción Involuntaria Nocturna, enuresis noct

urna Dutch nachtelijk bedplassen, bedwateren, Enuresis, enuresis; nachtelijk, nachtelijk; enuresis French Enurèse noct, Enurésie nocturne, Énurésie nocturne, Incontinence nocturne des urines, Incontinence urinaire nocturne German Bettnaessen, naecht.l Enuresis, naechtliche Enuresis, Enuresis nocturna, Bettnässen Italian Enuresi, Enuresi notturna, Incontinenza urinaria notturna Portuguese Enurese nocturna, Incontinência Urinária Noturna, Enurese Noturna, ENURESE NOCTURNA, Micção Involuntária Noturna, Micção durante o Sono, Micção Noturna Involuntária Russian ЭНУРЕЗ НОЧНОЙ, НОЧНОЕ НЕДЕРЖАНИЕ МОЧИ, NOCHNOE NEDERZHANIE MOCHI, ENUREZ NOCHNOI Swedish Enuresis | definition of enuresis by Medical dictionary

 Enuresis | definition of enuresis by Medical dictionary Related to enuresis: diurnal enuresis enuresis [en″u-re´sis] a type of urinary incontinence , usually referring to involuntary discharge of urine during sleep at night (nocturnal enuresis or bed-wetting ), such as in a child beyond the age when bladder control should have been achieved.

adj., adj enuret´ic. It can occur as a result of such organic conditions as structural defects or infections of the urinary tract, neurologic deficit and resultant loss of control, nocturnal epilepsy, diabetes mellitus and diabetes insipidus, which increase urine flow, and renal disorders that impair the kidney's ability to concentrate urine. If no organic basis can be found for bed-wetting, psychogenic factors are considered. Patient Care. Efforts to manage enuresis require patience on the part of parents and understanding that the child may be embarrassed by the condition and its effects. Reprimands and punishment are not appropriate and only make matters worse. The child also needs to be encouraged to participate in planning and implementing the program of care and to have hope and confidence that the problem can be overcome. Among the techniques used to manage nocturnal enuresis are restricting fluids after the evening meal, bladder training to help enlarge the capacity of the bladder, and fully awakening the child once or twice during the night to walk to the bathroom and urinate. Electronic devices that establish a conditioned reflex response to waken the child the moment urination starts are successful in some cases. An anticholinergic drug may be prescribed as an adjunct to any of these techniques.

desmopressin acetate nasal spray (DDAVP) may also be used. en·u·re·sis Enuresis - RightDiagnosis.com Enuresis: Stories from Users Enuresis: Introduction Enuresis: The involuntary discharge of urine occurring at night. See detailed information below for a list of 90 causes of Enuresis , Symptom Checker , including diseases and drug side effect causes. » Review Causes of Enuresis: Causes | Symptom Checker » Causes of Enuresis: The following medical conditions are some of the possible causes of Enuresis. There are likely to be other possible causes, so ask your doctor about your symptoms. Urinary tract obstruction Developmental delay (see Developmental problems ) Tethered cord » Review Causes of Enuresis: Causes | Symptom Checker » Home Diagnostic Testing and Enuresis Home medical tests possibly related to Enuresis: Child Behavior: Home Testing Causes of Types of Enuresis: Review causes of types of Enuresis in more specific categories: See full list of 1 types for Enuresis Enuresis: Symptom Checker Listed below are some combinations of symptoms associated with Enuresis, as listed in our database.

Visit the Symptom Checker , to add and remove symptoms and research your condition. Symptom Checker See full list of 501 Symptom Checkers for Enuresis Enuresis Treatments Some of the possible treatments listed in sources for treatment of Enuresis may include: Waiting- Almost all children will outgrow bedwetting Bedwetting alarms Review further information on Enuresis Treatments . Alternative Treatments for Enuresis Alternative treatments or home remedies that have been listed as possibly helpful for Enuresis may include: Avoid liquids before bedtime Stories from Users for Enuresis Real-life user stories relating to Enuresis: More Enuresis animations & videos Medications or substances causing Enuresis: The following drugs, medications, substances or toxins are some of the possible causes of Enuresis as a symptom. Always advise your doctor of any medications or treatments you are using, including prescription, over-the-counter, supplements, herbal or alternative treatments.

See full list of 8 medications causing Enuresis Enuresis: Comorbid Symptoms Causes of General Symptom Types Research the causes of these more general types of symptom: Causes of Similar Symptoms to Enuresis Research the causes of these symptoms that are similar to, or related to, the symptom Enuresis: Read more about causes and Enuresis deaths . Misdiagnosis and Enuresis Mild worm infections undiagnosed in children: Human worm infestations, esp. threadworm , can be overlooked in some cases, because it may cause only mild or even absent... read more » Mesenteric adenitis misdiagnosed as appendicitis in children: Because appendicitis is one of the more feared conditions for a child with abdominal pain, it can be over-diagnosed (it can, of course, also fail to be diagnosed with fatal effect).... read more » RLS sleep disorder causing night-time leg sensations often misdiagnosed: A common but relatively unknown sleep-related disorder called Restless Leg Syndrome (RLS) is often misdiagnosed. The typical symptoms are night-time tingling, crawling, or burning sensations in the...

read more » Blood pressure cuffs misdiagnose hypertension in children: One known misdiagnosis issue with hyperension, arises in relation to the simple equipment used to test blood pressure. The "cuff" around the arm to measure blood pressure... read more » Interstitial cystitis an under-diagnosed bladder condition: The medical condition of interstitial cystitic is a bladder condition that can be misdiagnosed as various conditions such as... read more » Children with migraine often misdiagnosed: A migraine often fails to be correctly diagnosed in pediatric patients. These patients are not the typical migraine sufferers, but migraines can also occur in children. See misdiagnosis of...

read more » Read more about Misdiagnosis and Enuresis Enuresis: Research Related Doctors & Specialists Child Health Specialists (Pediatrics): Classifications of Enuresis: Medical Conditions associated with Enuresis: Urinary symptoms (1228 causes), Urinary incontinence (289 causes), Sleep symptoms (1476 causes), Bladder symptoms (1010 causes), Urinary problems (1033 causes), Incontinence (359 causes), Sleeping problems (873 causes), Sexual symptoms (1838 causes), Urination symptoms (1228 causes), Urinary system symptoms (1228 causes), Digestive symptoms (5299 causes), Abdominal symptoms (5930 causes), Urinary difficulty (648 causes), Intercourse symptoms (258 causes), Nocturnal symptoms (698 causes), Lower abdominal symptoms (3048 causes), Incontinence symptoms (331 causes) Symptoms related to Enuresis: Urinary incontinence (289 causes), Nightmares (43 causes), Bedwetting (90 causes), Dreams, Nocturnal enuresis (90 causes

), NE , Primary nocturnal enuresis, PNE, Secondary nocturnal enuresis SNE, Nocturia (33 causes), Voiding dysfunction, Incontinence (359 causes), Overactive bladder (16 causes), Urge syndrome, Dysfunctional voiding, Cystitis , Constipation (726 causes), Neurogenic bladder (22 causes) Medical articles on signs and symptoms: Doctor-patient articles related to symptoms and diagnosis: Bedwetting & Sleep - National Sleep Foundation Home >> Sleep Disorders Problems >> Bedwetting Nocturnal enuresis is the medical term for bedwetting.

Most children wet the bed occasionally or even nightly during the potty-training years. In fact, it is estimated that seven million children in the United States wet their beds on a regular basis. Controlling bladder function during sleep is usually the last stage of potty-training. In others words, it is normal for children to wet the bed while sleeping during that learning process. Bedwetting is typically not even considered to be a problem until after age 7. Bedwetting in children is often simply a result of immaturity. The age at which children become able to control their bladders during sleep is variable. Bladder control is a complex process that involves coordinated action of the muscles, nerves, spinal cord and brain. In this case, the problem will resolve in time. On the other hand, it may be an indication of an underlying medical condition, such as obstruction of the urinary tract. If bedwetting persists beyond the age of 6 or 7, you should consult your pediatrician. There are both primary and secondary forms of bedwetting. With primary bedwetting, the child has never had nighttime control over urination.

The secondary form is less common and refers to bedwetting that occurs after the child has been dry during sleep for 6 or more months. Secondary bedwetting may be caused by psychological stress but may be the result of an underlying medical condition such as constipation or urinary tract obstruction. With secondary bedwetting, contact your doctor for an evaluation. Symptoms of Bedwetting: Bedwetting refers to involuntary urination during sleep in children over the age of 5. Bedwetting may occur at any point during the night but usually occurs during the first few hours of sleep. Occasional bedwetting for children over the age of 5 is not uncommon but if it happens more often than 2-3 times per month, parents should consult their pediatrician. How to Treat Bedwetting: Because bedwetting tends to happen during the first few hours of sleep, a good method of preventing it is to make sure that your child goes to the bathroom Pages Encopresis | definition of encopresis by Medical dictionary Encopresis | definition of encopresis by Medical dictionary Definition Encopresis is repeatedly having bowel movements in places other than the toilet after the age when bowel control can normally be expected.

Description Most children have established bowel control by the time they are four years old. After that age, when they repeatedly have bowel movements in inappropriate places, they may have encopresis. In the United States, encopresis affects 1-2% of children under age 10. About 80% of these are boys. Encopresis can be either involuntary or voluntary. Involuntary encopresis is related to constipation , passing hard painful feces, and difficult bowel movements. Often children with involuntary encopresis stain their underpants with liquid feces. They are usually unaware that this has happened. Voluntary encopresis is much less common and is associated with behavioral or psychological problems. Both types of encopresis occur most often when the child is awake, rather than at night. Causes and symptoms Although a few children experience encopresis because of malformations of the lower bowel and anus or irritable bowel disease, most have no physical problems to explain this disorder. Constipation is present in about 80% of children who experience involuntary encopresis. As feces moves through the large intestine, water is removed.

The longer the feces stays in the large intestine, the more water is removed, and the harder the feces becomes. The result can be hard or painful bowel movements. In response, children may start to hold back when they feel the urge to eliminate in order to avoid pain . This starts a cycle of constipation that results in retentive encopresis. Once elimination is avoided, the bowel becomes full of hard feces. This stretches the large intestine. Eventually the intestine becomes so stretched that liquid feces backed up behind the blockage is able to leak around the hard feces. Children with this type of encopresis do not feel the urge to have a bowel movement and are often surprised when their pants are stained with foul smelling liquid feces. This leakage of feces is called overflow incontinence. Parents sometimes mistake this soiling for diarrhea , because the feces expelled is liquid. Every so often, children with involuntary encopresis may pass large stools, sometimes with volumes big enough to clog the toilet, but the relief this brings is temporary. Although about 95% of encopresis is involuntary, some children intentionally withhold bowel movements.

The American Psychiatric Association (APA) recognizes voluntary encopresis without constipation as a psychological disorder. This disorder is said to occur when a child who has control over his bowel movements chooses to have them in an inappropriate place. The feces is a normal consistency, not hard. Sometimes it is smeared in an obvious place, but it may also be hidden from adults. Voluntary encopresis may result from a power struggle between caregivers and the child during toilet training, or the child may have developed an unusual fear of the toilet. It is also associated with oppositional defiant disorder (ODD), conduct disorder , sexual abuse , and high levels of psychological stress . For example, children who were separated from their parents during World War II were reported to have a high rate of encopresis. However, parents and caregivers should be aware that very few children soil intentionally and most do not have a behavioral or psychological problem and should not be punished for their soiling accidents. Diagnosis Diagnosis is based primarily on the child's history of inappropriate bowel movements. Physical examinations are almost always normal, except for a mass of hard feces blocking the lower intestine.

Other physical causes of soiling, such as illness, reaction to medication, food allergies , and physical disabilities, may also be ruled out through history and a physical examination . In addition, to be diagnosed with encopresis the child must be old enough to establish regular bowel control—usually chronologically and developmentally at least four years of age. Treatment The goal of treatment is to establish regular, soft, pain free bowel movements in the toilet. First the physician tries to determine the cause of encopresis, whether physical or psychological. Regardless of the cause, the bowel must be emptied of hard, impacted feces This can be done using an enema, laxatives , and/or stool softeners such as mineral oil. Enemas and laxatives should be used only at a doctor's recommendation. Next, the child is given stool softeners to keep feces soft and to give the stretched intestine time to shrink back to its normal size. This shrinking process may take several months, during which time stool softeners may need to be used regularly. Children also need two or three regularly scheduled toilet sits daily in an effort to establish consistent bowel habits. These toilet sits are often more effective if done after meals.

Maintaining soft, easy-to-pass stools is also important if the child is afraid of the toilet because of past painful bowel movements. A child psychologist or psychiatrist can suggest treatment for the rare child with serious behavioral problems such as smearing or hiding feces. Alternative treatment Many herbal stool softeners and laxatives are available as both tablets and liquids. Psyllium, the seed of several plants of the genus Plantago is one of the most effective. Other natural remedies for constipation include castor seed oil (Ricinus communis), senna (Cassia senna or Senna alexandrina), and dong quai Angelica polymorpha or Angelica sinensis). Prognosis For almost all children, once constipation is controlled, the problem of soiling disappears. This make take several months, and relapses may occur, but with effective prevention strategies, encopresis can be eliminated. Children who are in a power struggle over toileting usually outgrow their desire to have bowel movements in inappropriate places. The prognosis for children with serious behavioral and psychological problems that result in smearing or hiding feces depends largely on resolving the underlying problems. Key terms Feces — Waste products eliminated from the large intestine; excrement.

Incontinence — The inability to control the release of urine or feces. Laxative — Material that encourages a bowel movement. Stools — feces, bowel movements. The best way to prevent encopresis is to prevent constipation. Methods of preventing constipation include: increasing the amount of liquids, especially water, the child drinks adding high fiber foods to the diet (e.g. dried beans, fresh fruits and vegetables, whole wheat bread and pasta, popcorn) establishing regular bowel habits limiting the child's intake of dairy products (e.g. milk, cheese, yogurt, ice cream) that promote constipation. treating constipation promptly with stool softeners, so that it does not become worse. Resources Books American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. text revision. Washington D.C.: American Psychiatric Association, 2000. Periodicals Kuhn, Brett R., Bethany A. Marcus, and Sheryl L. Pitner. "Treatment Guidelines for Primary Nonretentive Encopresis and Stool Toileting Refusal." American Family Physician, 59, no.

8 (15 April 1999) 2171-2183. [cited 16 February 2005]. 〈〉. Organizations American Academy of Child and Adolescent Psychiatry, P. O. Box 96106, Washington, D.C. 20090. 800-333-7636. Other Borowitz, Stephen. Encopresis, 14 June 2004 [cited 20 February 2005]. 〈〉. incontinence 1. inability to control excretory functions. 2. immoderation or excess. adj., adj incon´tinent. bowel incontinence 2. a nursing diagnosis accepted by the North American Nursing Diagnosis Association, defined as a state in which an individual has a change in normal bowel habits, with involuntary bowel movements. continuous incontinence continuous urinary leakage from a source other than the urethra, such as a fistula. fecal incontinence (incontinence of the feces) inability to control defecation ; both physiologic and psychological conditions can be contributing factors.

Called also encopresis and bowel incontinence . See also bowel elimination, altered . Physiologic causes include neurologic sensory and motor defects such as those occurring in stroke and spinal cord injury; pathologic conditions that impair the integrity of the sphincters, such as tumors, lacerations, fistulas, and loss of sensory innervation; altered levels of consciousness ; and severe diarrhea. Psychological factors include anxiety, confusion, disorientation, depression, and despair. There is potential for physical and psychological stress when a person is unable to control his or her bowel movements. Damage to the integrity of the skin and its breakdown into pressure ulcers is always a possibility no matter how hard caregivers might try to keep the patient clean and dry. Psychologically the person is likely to suffer from loss of self-esteem and is certain to experience some alteration in self-image. From the time of toilet training a person is expected to be able to handle the tasks of bowel elimination. An adult who for some reason is no longer able to do this is often embarrassed by and ashamed of the inability to perform this most basic of self-care activities. Patient Care.

Assessment of the problem of fecal incontinence should be extensive and thorough so that a realistic and effective plan of care can be implemented. Sometimes all that is needed is a regularly scheduled time to offer the patient a bedpan or help using a bedside commode or going to the bathroom. If diarrhea is a problem it may be that dietary intake needs changing or tube feedings are not being administered correctly. Dietary changes may also help the patient who has a stoma leading from the intestine. In cases of neurologic or neuromuscular deficit, retraining for bowel elimination is a major part of rehabilitation of the patient. Frequently, it is possible to help a patient achieve control by means of a well-planned and executed bowel training program. Biofeedback techniques can be helpful in many cases. The person learns to maintain higher tone in the anal sphincter through use of a balloon device that provides feedback information about pressures in the rectum. With practice the person can learn better control and develop a more acute awareness of the need to defecate. functional incontinence incontinence due to impairment of physical or cognitive functioning.

functional urinary incontinence a nursing diagnosis accepted by the North American Nursing Diagnosis Association, defined as an inability of a usually continent person to reach the toilet in time to avoid the unintentional loss of urine. See also urinary incontinence . overflow incontinence (paradoxical incontinence) urinary incontinence due to pressure of retained urine in the bladder after the bladder has contracted to its limits; there may be a variety of presentations, including frequent or constant dribbling or symptoms similar to those of stress or urge incontinence . reflex incontinence the urinary incontinence that accompanies detrusor hyperreflexia . reflex urinary incontinence a nursing diagnosis accepted by the North American Nursing Diagnosis Association, defined as an involuntary loss of urine at somewhat predictable intervals, whenever a specific bladder volume is reached. See also reflex incontinence . risk for urge urinary incontinence a nursing diagnosis accepted by the North American Nursing Diagnosis Association, defined as the state of being at risk for involuntary loss of urine associated with a sudden strong sensation of urinary urgency. See also urge urinary incontinence . severe stress urinary incontinence severe stress incontinence as a result of incompetence of the sphincter mechanism.

stress incontinence urinary incontinence due to strain on the orifice of the bladder, as in coughing or sneezing. stress urinary incontinence a nursing diagnosis accepted by the North American Nursing Diagnosis Association, defined as loss of urine of less than 50 ml when there is increased abdominal pressure. See also stress incontinence . total urinary incontinence a nursing diagnosis accepted by the Seventh National Conference on the Classification of Nursing Diagnoses, defined as a state in which an individual has continuous and unpredictable loss of urine; see also urinary incontinence . urge incontinence (urgency incontinence) urinary or fecal incontinence preceded by a sudden, uncontrollable impulse to evacuate (see also urgency ). Urge incontinence of urine is a major complaint of patients with urinary tract infections and is also present in some women two or three days before onset of the menstrual period. urge urinary incontinence a nursing diagnosis accepted by the North American Nursing Diagnosis Association, defined as the involuntary passage of urine soon after feeling a strong sense of urgency to urinate; see also urge incontinence .

urinary incontinence (incontinence of urine) loss of control of the passage of urine from the bladder; see also enuresis . It can be caused by pathologic, anatomic, or physiologic factors affecting the urinary tract, as well as by factors entirely outside it. See also urinary elimination, altered . Patient Care. The Agency for Health Care Policy and Research (AHCPR) convened an interdisciplinary, non-Federal panel of physicians, nurses, allied health care professionals, and health care consumers that has identified and published Clinical Practice Guidelines for Urinary Incontinence in Adults. Identification and documentation of urinary incontinence can be improved with more thorough medical history taking, physical examination, and record keeping. Routine tests of lower urinary tract function should be performed for initial identification of incontinence. There are also situations that require further evaluation by qualified specialists. The guidelines provide an informed framework for selecting appropriate behavioral, pharmacologic, and surgical treatment and supportive services that can be used to treat urinary incontinence. The panel concluded that behavioral techniques such as bladder training and pelvic muscle exercises are effective, low cost interventions that can reduce incontinence significantly in varied populations.

Surgery, except in very specific cases, should be considered only after behavioral and pharmacologic interventions have been tried. The panel found evidence in the literature that treatment can improve or cure urinary incontinence in most patients. The address of the AHCPR is Agency for Health Care Policy and Research, P.O. Box 8547, Silver Spring, MD 20907. They can also be called toll free at (800) 358-9295. en·cop·re·sis The repeated, generally involuntary passage of feces into inappropriate places (for example, clothing). [G. enkopros, full of manure] encopresis

Question: In humans, the medical condition Enuresis is what involuntary function?
Answer: Urination