What is Bottom Wetting (Enuresis) in Children?
Enuresis is the recurrent incontinence of the child at an age when developmental urinary control is expected. Although it is most common during night sleep, some children may experience difficulties with urine control during daytime hours.
Bottom wetting is not a voluntary behavior of the child. Therefore, blaming, embarrassing, punishing, or comparing the child with other children does not help solve the problem and may increase the child's anxiety and sense of shame.
Primary and Secondary Enuresis
When bottom wetting begins is important for evaluation. There may be a different clinical history depending on whether the child has gained urine control in the past.
- Primary enuresis: The fact that the child has not yet gained urinary control at night for a long time.
- Secondary enuresis: It is the resumption of underwetting in a child who has previously been dry for a certain period of time.
It is important to evaluate the changes in the child's life, stressors and possible medical causes together, especially in the reintroduced soaking.
What is Fecal Incontinence (Encopresis)?
Encopresis is a condition characterized by repetitive or abduction of stool to inappropriate locations during the period when developmental bowel control is expected.
In some children, prolonged constipation, stool retention behavior, and painful defecation experiences can be an important part of the process. Therefore, it should not be considered that fecal incontinence is only a behavioral or psychological problem.
What are the Causes of Bottom Wetting and Fecal Incontinence?
Not every child has the same cause. Developmental, biological, behavioral, familial and psychosocial factors may play different roles in the emergence of the problem.
- Developmental characteristics of urine and intestinal control
- Having a family history of bottom wetting
- Characteristics associated with bladder functions
- Factors associated with sleeping and waking patterns
- Constipation and stool retention behavior
- Difficulties in acquiring toilet habits
- Anxiety and intense stress experiences
- Starting or changing school
- Significant changes in moving and living arrangements
- Sibling birth
- Significant changes or breakups within the family
- Traumatic or compelling life events
- Some concomitant medical conditions
Are Psychological Factors Always Why?
No. The presence of lower wetting or stool incontinence alone does not mean that the child has a psychological problem. Developmental and medical factors should be considered, especially when evaluating enuresis and encopresis.
However, anxiety, stress, changes in family life, or challenging events experienced by the child may accompany the appearance, resumption, or continuation of symptoms in some children.
How is Assessment Performed in Children?
The evaluation does not only look for the presence of bottom wetting or fecal incontinence. The general development of the child and the conditions in which the symptoms occur are discussed together.
The following areas can be evaluated during the interviews:
- Time and frequency of onset of symptoms
- Characteristics of night and day symptoms
- Whether toilet control has been gained before
- Potty training and toilet habits
- Constipation and intestinal pattern
- Sleep pattern
- The child's developmental history
- School and social life
- Anxiety, fear and other emotional symptoms
- Significant changes in family life
- Parents' approach to the problem
When is Medical Evaluation Important?
It is important to evaluate the possible physical causes of lower wetting and stool incontinence. Medical evaluation may be required, especially in case of new onset of symptoms, daytime urinary incontinence, pain or burning while urinating, recurrent urinary tract problems, marked constipation, painful defecation, or other accompanying physical symptoms.
When necessary, cooperation can be made with pediatric health and diseases, pediatric urology or other relevant medical specialties.
What Can Be Done in the Process of Psychological Support?
The psychological support process is planned individually according to the age of the child, developmental characteristics, the nature of the problem and the evaluation result.
The following studies can be used when deemed appropriate:
- Information for children and parents
- Arrangement of toilets and daily life routines
- Behavioral follow-up methods
- Arrangement of positive reinforcement systems
- Coping with anxiety and stress
- Emotion recognition and emotion regulation skills
- Play-based studies appropriate for the age of the child
- Evaluation of parental attitudes
- Parent mentoring
The aim is not to keep the child under pressure or to force him/her to stay dry in a short time; it is to identify the factors that contribute to the problem and to create a support process suitable for the development of the child.
How Should Parents Approach?
- Do not punish or embarrass the child.
- Don't blame the child for wetting himself or leaking stools.
- Don't compare them to their siblings or friends.
- Don't make a mockery or joke of the problem in the family.
- Protect the child's privacy.
- Support positive behaviors.
- Help keep toilet routines organized.
- Get a professional evaluation if the problem persists.
When to seek help
Comprehensive assessment may be helpful if lower wetting or stool incontinence is recurrent, has resumed after previously acquired toilet control, is affecting the child's self-confidence or social life, causes marked conflict within the family, or is accompanied by other symptoms, such as anxiety and behavioral problems.
In line with the needs of the child, a support plan can be created in cooperation with psychological evaluation, parental counseling and, if necessary, relevant health professionals.