Bowel and bladder evacuation may be learned concurrently. However, bowel control is likely to be established before bladder elimination, and daytime control of bladder occurs several months or years before nocturnal control. About 50% of 2-year-old children will be dry during the day. At the age of 3 years about 85%. Of children will have achieved bladder control, and about 90% by the age of 4 years.
Nocturnal enuresis may be a developmental phenomenon which appears to have some genetic implications. In such instances there is usually a positive family history of enuresis. Neurosis as a cause of bed-wetting may be associated with excessively vigorous efforts at toilet training. The physician will need to consider the possibility of organic genitourinary pathology.
Once the physician is satisfied that no organic pathology exists, supportive counseling is the principal treatment. Some success has been achieved with medications such as imipramine. Conditioning types of treatment, where a bell rings when a child voids, have also been found useful.
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