Aetiology

Enuresis is the result of an interaction between physiological and psychological factors including (i) family history (the strongest predictor of the age at which a child attains nocturnal bladder control is the number of first-order relatives having a known history of enuresis), (27) (ii) delays in physical development, for instance deficiencies in ADH secretion and in muscular responses to inhibit urination, (28) and (iii) learning history, in this case a failure to learn how to respond to the need to urinate.(3) It is not generally caused by emotional problems or psychological trauma, although secondary onset diurnal enuresis may be triggered by an emotional event. These children are more likely to suffer emotional problems as a result of the enuresis rather than the reverse. (29>

Encopresis is the result of biological, emotional, and learning factors. It is often, but not always, the result of chronic constipation. These children show significantly different patterns of defecation. (30) Children may learn to withhold faeces voluntarily, leading to severe constipation. Children with encopresis show significantly more emotional and behavioural problems and poor social competence than normal controls. Elevated behaviour problem scores are related to a poor treatment outcome.(31) The reduction of behaviour problems after the successful treatment of encopresis suggests that the encopresis may have an aetiological role in the behaviour problems rather than vice versa. (32>

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