What causes pediatric enuresis

  The age at which normal children learn to control their bowel movements varies widely. In general, children aged 1 to 2 years are not yet able to control their own bowel movements, and more than half of children aged 2 to 3 years can control their bowel movements. However, control of nocturia (that is, waking up after falling asleep to urinate without wetting pants or bed sheets) is still poor, and most children can control nocturia only when they are 4 to 5 years old, and they should be able to control nocturia completely after the age of 5. Children who are unable to control urination by the age of 5 are called enuresis. Enuresis can be divided into two main categories, primary enuresis and secondary enuresis. Primary enuresis is defined as the failure to control urination after sleep since birth, mostly functional, with no clear cause, but 80% of children with enuresis only have a smaller bladder capacity than normal children of the same age. Secondary enuresis refers to children who have been able to control urination after sleep for a period of time after birth (usually more than 1 year), but then enuresis is caused by disease, environmental factors or emotional factors.  Secondary enuresis is often caused by certain diseases, such as urological diseases like urethritis, cystitis or diseases of other organs of the body; temporary enuresis can also occur after surgery, especially febrile diseases, which affect the nervous system or when the child’s general weakness causes dysfunction. Once the original disease improves and the general condition improves, the enuresis will disappear. Another situation is that of psychological factors, such as fright, threats, severe criticism and punishment, or changes in urination habits due to chronic stress or sudden unfortunate events. For children with secondary enuresis, we should actively treat all kinds of primary diseases and improve the general condition of the child, and secondary enuresis will be cured soon.  In primary enuresis, the first step is to ask about possible psychological factors, such as whether the child has been severely reprimanded or ridiculed for poor schooling or discipline problems; whether the child has been emotionally disturbed and worried by parental discord; whether the child has been asked by the school or parents to make demands that they have tried hard but cannot meet, and to put pressure on them so that they cannot cope with them, resulting in physiological dysfunction and enuresis. Sometimes what seems to be a legitimate demand from adults is harsh to children, and this strict demand becomes a psychological factor, which is often overlooked.  Treatment for enuresis includes wake-up calls (gradual development of a biological clock), alarms, medication, acupuncture and biofeedback. Commonly used medications include chloroester awakening and ephedrine, etc. Chinese herbal medicine includes shrinking spring pills with enuresis, which is effective.