It should be noted that enuresis is a symptom, not a disease state. This includes maturation delay, abnormal acquired toilet training habits and stress. Finally, functional enuresis refers to dysfunctional voiding without a neurogenic or anatomic cause. Constipation can also cause an obstruction when there is a large dilated distal colon which impinges on the bladder. posterior urethral valves) or a defect that bypasses the bladder outlet. Such anatomical abnormalities include obstruction of the bladder outlet (e.g. Children with an anatomical cause for their enuresis usually present with primary enuresis. These can both disrupt the normal innervations required for voiding. meningomyelocele) and trauma to the central nervous system. Neurogenic causes include congenital anomalies (e.g. Urinary incontinence results from any disruption in the normal voiding process. There are multiple possible etiologies for enuresis that can be classified as neurogenic, anatomic and functional. Persistence of enuresis into adolescence or adulthood may reflect a variety of underlying conditions. Secondary enuresis is a relapse of incontinence following at least a 6 month period of dryness, often associated with psychosomatic causes. It is usually due to a developmental delay or a urologic abnormality. Primary enuresis is urinary incontinence in a child who has never been continent. Each type can further be classified as either primary or secondary enuresis. Nocturnal enuresis is much more common than diurnal enuresis. There are two types of enuresis: nocturnal (nighttime) and diurnal (daytime). It fortunately often spontaneously resolves by adolescence. It affects 30% of four-year-old children, 10% of six-year-olds and 3% of twelve-year-olds and is linked to a positive family history in 50% of cases. Enuresis is two to three times more common in boys than girls. Bladder control evolves from complete incontinence in infancy to daytime urinary continence by age 4 and finally nighttime continence by age 5 to 7 years. Urinary continence is dependent upon complex interactions between the somatic and autonomic nervous systems and involves both a filling and voiding phase. The bladder functions to both store and eliminate urine. It is the most common urologic disorder in children. Enuresis is defined as involuntary bladder emptying (urinary incontinence) in a child who is considered adequately mature to have achieved continence.
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