Definition

• "Giggle" enuresis is the emptying of the bladder during giggling or hearty, vigorous laughter. The child completely empties her bladder when she is laughing and is unable to control her bladder. (See Voiding Dysfunction in Children, paragraph 5.)
  
  

Voiding Dysfunction

• This type of enuresis is part of a larger syndrome, called "voiding dysfunction." This medical term is used to describe an abnormal pattern of urination for the child's developmental age. The problem could be happening when the bladder fills with urine or it could be taking place as she tries to empty her bladder in the bathroom. If she is having physical problems with her bladder or with the urethral sphincter, these will not function in a way which allows her to fully and normally empty her bladder. (See Voiding Dysfunction in Children, paragraph 1.)
  
  

Causes

• The most direct cause of giggle enuresis is stress incontinence, which means the child involuntarily loses urine and wets himself when he laughs, sneezes or coughs. Stress incontinence is most commonly associated with increased intra-abdominal (in the abdomen) pressure. His doctor will need to perform a physical and order tests to see if there is a physical reason for his enuresis. These will include social and medical histories, including a diary for the parents to fill out. He will also order a neurological exam, including the lower extremities for sensation, tone, strength and reflexes. The child will also undergo lab tests such as a urinalysis, blood tests and a urine culture to look for infections. He will also have tests such as a voiding cytourethrogram, renal/bladder ultrasound and an MRI of the lower spine. He may also undergo a renal scan which looks at kidney function and possible kidney damage. (See Voiding Dysfunction in Children, paragraphs 4 and 6 and Diurnal Enuresis, paragraph 1.)
  
  

Signs of Enuresis

• Signs that the child has developed enuresis include urine leakage during the day and/or night; urinary hesitancy (dribbling, intermittent urine flow or straining to urinate; recurrent urinary tract infections; blood in the urine; pain in the back, abdomen or flank; going more often or having to go more urgently; not going very often (less than four urinary voids in 24 hours); and constipation and/or soiling her pants with feces. (See Voiding Dysfunction in Children, paragraph 3.)
  
  

Treatments

• Once the doctor has found a cause of enuresis, he can treat the child. His approach will depend on how severe the problem is. Depending on whether the cause is physical or emotional, he will target constipation management, treating and managing recurrent UTI's, finding and eliminating irritants to the child's bladder (possibly caffeinated or carbonated beverages, citrus juices or chocolate).
  
  If he finds that the child's enuresis is related to behavioral issues, he will prescribe a regimen in which the child is taught to recognize when he has to go to the bathroom. He will be taught how to control his need to empty his bladder.
  
  The child may also be put on a high-fiber diet, as well as on a bathroom schedule. He may also be given exercises to strengthen his urethral sphincter (Kegel exercises).