What is the most common cause of Enuresis among children?

RUHS, Jaipur, PB B.Sc Nursing Entrance-2020

Child Health Nursing (Pediatrics)

Hard

Appeared in: RUHS, Jaipur, PB B.Sc Nursing Entrance-2020

Explanation

Enuresis is the repeated, involuntary urination in bed or clothes after the age of 5, when bladder control is expected.
It is classified as primary (child has never achieved consistent dryness) or secondary (relapse after at least 6 months of dryness).
Psychosocial stressors are a primary precipitating factor for secondary enuresis.
Events like the birth of a sibling, starting school, or family conflict can trigger a relapse of bedwetting, making psychological distress a common cause among the options.

Option A: Somnambulism (sleepwalking) is a separate sleep disorder (parasomnia). While it can co-occur with enuresis, it does not cause it.
Option B: While a UTI can cause enuresis by irritating the bladder, organic causes are responsible for less than 5% of cases. It is an important differential diagnosis but not the most common cause.
Option C: Tourette Syndrome is a neurological disorder characterized by motor and vocal tics. It has no direct causal relationship with enuresis.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Causes of Enuresis in Children as background academic context rather than a clinical decision trigger.
A key nursing role is to take a thorough history to differentiate between primary and secondary enuresis, which helps guide the investigation into potential causes (developmental vs. psychological/organic).
Patient and family education is critical. Nurses must reassure the family that enuresis is common, not the child's fault, and that punishment is counterproductive and can worsen the issue.
What if? If the child also complained of dysuria (painful urination), urgency, and fever, the priority would shift to suspecting a Urinary Tract Infection (UTI). The immediate nursing action would be to obtain a urine sample for culture and sensitivity before exploring psychological factors.

How to Approach the Question

First, understand the question is asking for the 'most common cause' of enuresis from the given list.
Define enuresis: involuntary urination after age 5.
Evaluate each option's link to enuresis. Recall that the most common cause of primary enuresis (maturational delay) is not an option.
Eliminate unrelated conditions. Tourette Syndrome is a tic disorder, and Somnambulism is a separate sleep disorder; neither directly causes enuresis.
Compare the remaining plausible options: UTI and psychological distress. Remember that organic causes like UTIs are less frequent than functional or psychological causes.
Conclude that psychological distress is a major trigger for secondary enuresis and is considered a more common cause overall than UTIs, making it the best choice among the options.

Concept Tested & Keywords

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E6 Kaplan Sadock's Synopsis of Psychiatry-2022 (pp 1-3768 of 3768) pp. 1541-1543, 1544-1546

E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 1098-1100