Incontinence, which is common in childhood, is a physiological and/or psychological condition that distresses the child and his/her parents in case of Enuresis (urinary incontinence) after the age of 5 and Encopresis (fecal incontinence) after the age of 4. It is normal for children to experience bedwetting problems at night until bladder control is achieved, approximately between the ages of 2 and 3. Since the need to go to the toilet requires adequate muscle control, children continue to acquire the ability to go to the toilet until the age of 4. The child's bowel and bladder control begins with nightly stool control; Then, it ends with daytime stool control, daytime urine control and finally night urine control.
DSM-V divides bedwetting disorder into 3:
The situation in which involuntary incontinence occurs only at night, during sleep is called enuresis nocturnal.
The situation in which involuntary incontinence occurs only in the daytime while awake is called enuresis. It is called diurnal.
The occurrence of involuntary incontinence both during sleep at night and during wakefulness during the day is called enuresis nocturnal and diurnal. p>
Enuresis is divided into two groups: Primary enuresis and Secondary enuresis.
1.) Primary enuresis. : It is a condition in which the child has never gained control of his or her bladder since infancy. Generally, 80% of children suffering from enuresis are in this group. It is more common at night and mostly occurs in the form of nocturnal urinary incontinence. Primary enuresis is mostly caused by genetic predispositions, biological and developmental factors, and inadequate and irregular toilet training by parents.
2. Secondary enuresis: Secondary enuresis is when the child starts to incontinence again after not passing urine for at least 6 months and 1 year and having a dry period. An important distinction here is that the child has gained toilet training and the bedwetting problem begins after he has achieved toilet control. This condition accounts for 20% of children experiencing Enuresis. It is often seen between the ages of 5-8. Secondary Situations that cause enuresis are generally physiological and/or psychological reasons.
Causes of Enuresis
Biological Causes:
• Genetic background: Having parents or close relatives with enuresis problems in childhood may cause the child to have enuresis problems. Studies have shown that parents of children with bedwetting problems also experienced this problem in their childhood.
• Hormonal Factors: While the excretion of urine from the body is higher during the day, this rate decreases 2-3 times at night. In children with enuresis problems, failure of this excretion to decrease at night may cause children to have bedwetting problems.
• Problems related to bladder and kidney
• Developmental disorders
• Side effects of the drugs used
• In some children, the problem of not being able to wake up from deep sleep may also cause enuresis.
Psycho-social Causes:
• Mother's pregnancy or sibling jealousy
•Toilet training may not affect the child. giving it when it is not ready or wrong toilet training attitudes. For example: Punishing the child, getting angry, yelling and being stubborn.
•Wrong and inadequate parental attitudes: A passive response to a very harsh, oppressive parent or a babyish attitude towards an overprotective, possessive parent.
•Negative life events experienced by the child: As a result of fights in the family, arguments, parental separation, beating, violence, sibling jealousy, having a new sibling, moving, migration, illness, death, problems at school. The feeling of intense anxiety that arises can cause enuresis.
It is a situation where, despite having reached maturity, he/she defecates in his/her bottom or in inappropriate places. For a child over the age of 4, if he or she performs repetitive pooping behavior and this behavior occurs once a month for at least 3 months and is not caused by a medical condition. It is the state of not being connected.
Encopresis is divided into two groups: Primary encopresis and Secondary encopresis.
1.) Primary encopresis: It is seen when the child does not develop any control over holding his/her stool from infancy until the age of 4.
2.) Secondary encopresis: The child It is seen when you start to leak your stool after being able to control your behavior for at least 1 year.
It is also an important point whether the fecal incontinence is due to constipation or not. If it is due to constipation, first of all, it is necessary to prevent constipation by applying a suitable nutrition program for the child with medical support. If the problem is not related to constipation, psychological evaluation is very important.
Causes of Encopresis
Biological Causes:
•Intestinal disorders
•Constipation
•Developmental disorders
Psychosocial Causes:
•Negative life events experienced by the child: Quarrels within the family, arguments, parental separation, beating, violence, sibling jealousy, having a new sibling, moving, migration, illness, death, intense anxiety resulting from problems at school. Feeling of anxiety may cause enuresis.
•The mother is very meticulous
•Toilet training is given at an age when the child is not ready, inadequate education is provided, or the child is exposed to pressure or coercion during education. .
• Wrong and inadequate parental attitudes. A passive response to a very harsh, oppressive parent or a babyish attitude towards an overprotective, possessive parent.
•The child has not been able to develop toilet skills due to attention deficit and hyperactivity disorder
•The child has a stubborn personality and resistance to toilet training
Ways to Prevent Enuresis and Encopresis
Providing psychological support to the child has an important place in the treatment of primary enuresis and encopresis. is.
First of all, you should start toilet training your child when he is ready. Children aged 1.5-2 are ready to receive toilet training. The first thing that should not be done is to diaper the child, this situation reinforces the situation rather than being a precaution. When giving toilet training, explain how you go to the toilet and inform the child about using the potty by showing him how to do it.
Do not punish toilet accidents, do not raise your voice or shout. Punishments are not instructive. “Do you need to go to the toilet?”, “Do you have a toilet?” Instead of saying "Check your underwear, see if it's dry" at regular intervals, it is more helpful as a reminder. In this way, your child's awareness of responsibility will develop and he/she will feel that he/she has more control over the problematic issue he/she is experiencing. As a result, it helps the child feel grown up as he feels able to take responsibility for himself and take care of himself. If you get the answer "dry," say a rewarding, supportive sentence to reinforce your child's behavior, such as "It's nice that the underwear is dry." The more often you repeat the importance of staying dry, the faster your child will realize the benefits of not wetting the bed. Additionally, when he is not wetting the bed, you can benefit from small rewards such as "It's great that your diaper is not wet, now we can play a game you want together", "We can read a fairy tale you like" or "We can watch a cartoon you like".
You can speed up your child's ability to go to the toilet by repeating the exercises of going to the toilet frequently during the day, along with calm and gentle reactions in case his/her diaper is wet when you ask. Your child does not need to pee or poop during the toilet exercises you do during the day, the important thing is to ensure that the correct toilet movements are acquired.
Take care to drink the fluid your child needs during the day so that your child's body does not become dehydrated. Try to stop drinking fluids 2 hours before going to bed and make sure you go to the toilet before going to bed. �n. Apart from this, when he comes to the toilet during the day, ask him to hold the toilet for 1 minute and give him a small reward when he does. Increase the time gradually by 2 minutes, 3 minutes. This helps increase the capacity of the urinary bladder. Ensure your child's active participation in changing the bed sheets or changing clothes in case he or she wets the bed.
If fecal incontinence continues after the age of 4, it is defined as encopresis, and if urinary incontinence continues after the age of 5, it is defined as enuresis. It is very important to take a detailed history of the child before proceeding with the treatment of enuresis and/or encopresis. A specialist should be consulted to investigate whether there is a physiological problem and to perform medical examinations. In addition, it is necessary to get psychological support from an expert to examine in detail the psychological reasons underlying incontinence.
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