PubMed1993
Bladder control is a developmental process which is determined by somatic, individual psychological and psychosocial factors. It depends on the maturation of bladder capacity and of adequate neuromuscular coordination, on the quantity of urine and on appropriate recognition of bladder expansion. The latter especially is clearly correlated to healthy individuation and psychosocial integration of the child. Statistically, 80-90% of children have successfully developed bladder control at the age of 4-6 years. In the remaining 10 or 20% who do not attain dryness during daytime or at night, wetting is often felt to be disturbing state, sometimes more by the parents than by the children. The state is called enuresis. The physician is expected to master the problem of night or daytime enuresis diagnostically as well as therapeutically. Although in most cases enuresis represents a retardation of normal development, it is important not to miss the rare, but, if present, important disturbing factors. Disorders can occur at all above mentioned levels, either in isolation or combined. Although proposing the simplest diagnostic measures, the present paper represents an optimal workup during which none of the rare somatic or complicated psychological disturbances, which would need specialized attention, should be missed. After this workup the therapeutic pathways are clear. On the one hand, relevant somatic and/or psychological disorders must be treated specifically (often in collaboration with the specialist). On the other side, there is the large number of enuretics who are, by all criteria, normal children. In these it is possible to accelerate the developmental process by performing an elaborate micturition protocol which has a good chance of success, provided, however, there is optimal cooperation between physician, parents and child.