Psychiatric Nursing

Enuresis

Enuresis is defined as the involuntary or intentional voiding of urine either during the day or night, at inappropriate places. This condition is common in infancy. Children achieve bladder control by the age of 3 years and still 7% children after 5 years wet their bed.

Types:

• Primary' type in which the individual has never established urinary continence
• Secondary' type in which the disturbance develops after a period of established urinary continence, usually at 5-8 years of age.

a. Nocturnal- Episodes occurring only at night are referred to as nocturnal

b. Diurnal- daytime wetting is labelled diurnal.

Etiology

• Psychological disturbance: Children living in socially disadvantaged situations and experiencing psychosocial stress have a greater frequency of enuresis.
• Genetic: 75% of enuretics have a first degree relative with h/o enuresis

Treatment

• Restriction of fluid intake after 8 PM, in nocturnal enuresis.
• Bladder training during daytime- increasing holding time of the bladder.
• Interruption of sleep before the expected time of bed wetting
• Conditioning devices which cause alarm to sound as soon as the voided urine touches the bed sheet.
• Supportive psychotherapy to child and parents.
• Pharmacotherapy with imipramine 25-75 mg/day -drug of choice or DZM to reduce stage 4 NREM sleep.

Encopresis

• Encopresis is an elimination disorder characterised by following features
• Encopresis is repetitive passage of feces at inappropriate time and/or place, after bowel control is physiologically possible.
• This is no due to the presence of any organic cause, which is called fecal incontinence.
• more common (3-4 times) in males
• 25% have associated enuresis

Types:

1. Primary type: where toilet training has never been achieved
2. secondary type: where Encopresis emerges after a period of fecal continance

Etiology

1.    Inadequate, inconsistent toilet training.

2.    Sibling rivalry

3.    maturational lag

4.    underlying hyperkinetic disorder

5.    emotional disturbances

6.    mental retardation

7.    childhood schizophrenia

Treatment

• Evaluate for organic causes.
• Family interventions- Warm and understanding family environment.
• Behaviour therapy- with positive and negative reinforcements.
• Preventive care- consistent and smooth toilet training.
• Supportive psychotherapy.