Giggle incontinence
Encyclopedia
Giggle incontinence, giggle enuresis or enuresis risoria is the involuntary release of urine
in response to giggling
or laughter. The bladder
may empty completely or only partially.
Giggle incontinence is more common in children than adults, typically appearing at ages 5 to 7, and is most common in girls near the onset of puberty
. The condition tends to improve with age, with fewer episodes during the teenage years, but may persist into adulthood. A survey of 99 student nurses indicated that about 25% had experienced such a wetting event during their lifetime, and about 10% were still susceptible in their late teens.
Giggle incontinence is a special form of urge incontinence
, and is not the same as stress incontinence
, which is generally brought on by participating in vigorous sport.
, the bladder's normally relaxed detrusor muscle
contracts to squeeze urine from the bladder.
One study, of 109 children diagnosed with giggle incontinence at Schneider Children's Hospital in New York, concluded that the cause of giggle incontinence is involuntary contraction of the detrusor muscle induced by laughter.
Because the complaint is difficult to reproduce under controlled conditions, its triggering mechanism is not clearly understood, but may be related to cataplexy
, a sudden transient episode of loss of muscle tone
often triggered by strong emotions.
and socially incapacitating, diminishing the quality of life. Those having the condition learn to adapt by avoiding activities that may bring on laughter. Other approaches include limiting fluid intake, trying to remain seated, and concealing leakage by wearing absorbent pads and dark clothing.
(Ritalin) has been reported, but this treatment option is not acceptable to all patient families.
Dr. Lane Robson, of The Children’s Clinic in Calgary, Alberta, says "If a child is having a wetting episode once a month, medicating them daily is probably not a good treatment. If it’s a daily issue, you may have to make that decision."
Urine
Urine is a typically sterile liquid by-product of the body that is secreted by the kidneys through a process called urination and excreted through the urethra. Cellular metabolism generates numerous by-products, many rich in nitrogen, that require elimination from the bloodstream...
in response to giggling
Giggle
A giggle is a high-pitched, bubbly way of laughing. It is usually suppressed, resulting in short bursts of laughter. A giggle is often considered a very feminine laugh. Giggling is sometimes affiliated with laughing gas a dentist would administer. Giggling is also sometimes done nervously. Giggling...
or laughter. The bladder
Urinary bladder
The urinary bladder is the organ that collects urine excreted by the kidneys before disposal by urination. A hollow muscular, and distensible organ, the bladder sits on the pelvic floor...
may empty completely or only partially.
Giggle incontinence is more common in children than adults, typically appearing at ages 5 to 7, and is most common in girls near the onset of puberty
Puberty
Puberty is the process of physical changes by which a child's body matures into an adult body capable of reproduction, as initiated by hormonal signals from the brain to the gonads; the ovaries in a girl, the testes in a boy...
. The condition tends to improve with age, with fewer episodes during the teenage years, but may persist into adulthood. A survey of 99 student nurses indicated that about 25% had experienced such a wetting event during their lifetime, and about 10% were still susceptible in their late teens.
Giggle incontinence is a special form of urge incontinence
Urge incontinence
Urge incontinence is a form of urinary incontinence.Urge incontinence is involuntary loss of urine occurring for no apparent reason while feeling urinary urgency, a sudden need or urge to urinate.-Causes:...
, and is not the same as stress incontinence
Stress incontinence
Stress incontinence is a form of urinary incontinence.Stress urinary incontinence , also known as effort incontinence, is due essentially to insufficient strength of the pelvic floor muscles.-Pathophysiology:...
, which is generally brought on by participating in vigorous sport.
Cause
In voluntary urinationUrination
Urination, also known as micturition, voiding, peeing, weeing, pissing, and more rarely, emiction, is the ejection of urine from the urinary bladder through the urethra to the outside of the body. In healthy humans the process of urination is under voluntary control...
, the bladder's normally relaxed detrusor muscle
Detrusor urinae muscle
The detrusor urinae muscle, also detrusor muscle, muscularis propria of the urinary bladder and muscularis propria, contracts when urinating to squeeze out urine. Otherwise, it remains relaxed to allow the bladder to fill...
contracts to squeeze urine from the bladder.
One study, of 109 children diagnosed with giggle incontinence at Schneider Children's Hospital in New York, concluded that the cause of giggle incontinence is involuntary contraction of the detrusor muscle induced by laughter.
Because the complaint is difficult to reproduce under controlled conditions, its triggering mechanism is not clearly understood, but may be related to cataplexy
Cataplexy
Cataplexy is a sudden and transient episode of loss of muscle tone, often triggered by emotions. It is a rare disease , but affects roughly 70% of people who have narcolepsy...
, a sudden transient episode of loss of muscle tone
Muscle tone
In physiology, medicine, and anatomy, muscle tone is the continuous and passive partial contraction of the muscles, or the muscle’s resistance to passive stretch during resting state. It helps maintain posture, and it declines during REM sleep.-Purpose:Unconscious nerve impulses maintain the...
often triggered by strong emotions.
Social consequences
Episodes of giggle incontinence are embarrassingEmbarrassment
Embarrassment is an emotional state of intense discomfort with oneself, experienced upon having a socially unacceptable act or condition witnessed by or revealed to others. Usually some amount of loss of honour or dignity is involved, but how much and the type depends on the embarrassing situation...
and socially incapacitating, diminishing the quality of life. Those having the condition learn to adapt by avoiding activities that may bring on laughter. Other approaches include limiting fluid intake, trying to remain seated, and concealing leakage by wearing absorbent pads and dark clothing.
Treatment
Favorable response to treatment with the ADHD drug methylphenidateMethylphenidate
Methylphenidate is a psychostimulant drug approved for treatment of attention-deficit hyperactivity disorder, postural orthostatic tachycardia syndrome and narcolepsy. It may also be prescribed for off-label use in treatment-resistant cases of lethargy, depression, neural insult and obesity...
(Ritalin) has been reported, but this treatment option is not acceptable to all patient families.
Dr. Lane Robson, of The Children’s Clinic in Calgary, Alberta, says "If a child is having a wetting episode once a month, medicating them daily is probably not a good treatment. If it’s a daily issue, you may have to make that decision."