Enuresis

Enuresis is the intentional or involuntary voiding of urine into clothes orother inappropriate places by a child who is at least 5 years old. To meet thecriteria for enuresis, the involuntary or intentional voiding must occur at leasttwice a week or more for three months.

What is going on in the body?

In a child with enuresis, there is no physical disorder. Primaryenuresis occurs when bladder control has never been achieved. Secondaryenuresis occurs when bladder control has been achieved for at least one yearbut has then been lost. Enuresis may occur only at night, only in the day, orduring both day and night.

What are the causes and risks of the condition?

Causes of enuresis are usually psychosocial and physiologic. Children withenuresis often have other developmental delays. They tend to have smallerbladders and a higher likelihood of a learning disability. A link between enuresis and asleep disorder may beinvolved, but there is no clear proof of this.

Genetics may also play a role in the development of enuresis. Having oneenuretic parent increases the chance of the child having enuresis by 45%. If both parents are enuretic, the risk increases to 75%.Abouttwice as many males as females are enuretic.

Some cases of enuresis are related to toilet training that was begun too early or was very forcible.Enuresis may be a temporary regression or an adjustment problem. Parents whoare very controlling and quick to find fault may also trigger problems with bladdercontrol.

Medical causes of enuresis include the following:

bladder stones

constipation

diabetes insipidus

diabetes mellitus

epilepsy

lower urinary tract obstruction

neurogenic bladder, which is a bladder with impaired nerve function

sleep apnea,which is a breathing disorder that occurs during sleep

stress

urinary tractinfection

What are the signs and symptoms of the condition?

A child with enuresis urinates into clothing or other inappropriate places. The urination may be accidental or intentional. Nighttime enuresisis the most common.

How is the condition diagnosed?

A healthcare provider will conduct a thorough physical exam. He or she will checkfor any physical causes. A complete medical, developmental, and psychosocialhistory should be done. This will help determine what factors may be contributing to theproblem. The provider may order a urinalysis, which is a urine test to check for infection or otherabnormalities. More complex tests of the urinary tract may be done if anydisorders are suspected.

What can be done to prevent the condition?

There is no way to prevent enuresis caused by problems with development oranatomy. Parenting problems can be addressed with family therapy. It’simportant to start toilettraining only when the child is ready. When toilet training doesbegin, there should not be pressure on or criticism of the child. Helping childrenprepare for stressful events can help prevent enuretic episodes in response tostress.

What are the long-term effects of the condition?

If the enuresis is not treated, it may cause emotional and developmentalproblems for the child.

What are the risks to others?

Enuresis is not contagious and poses no risk toothers.

What are the treatments for the condition?

Treatment of enuresis falls into three categories. These are behavioral,medication, and counseling. Usually more than one treatment is used at a time.

Behavioral treatment includes:

behavioral rewards for achieving bladder control

bladder training, such as bladder stretching exercises to graduallyincrease the size of the bladder

conditioning methods, such as using a bedwetting alarm that awakens thechild if the bed gets wet

decreasing evening fluids

teaching the child to attend and respond to bladder sensations atnight

Medication is not the first treatment choice. It is often not used at all.Medication is used only when the problem interferes with the child’s ability tofunction or only for special occasions.

Counseling alone is rarely effective. A behavioral treatment regime needs to beestablished. Managing family stress and tension is important.

What are the side effects of the treatments?

Medications used to treat enuresis may cause allergic reactions. One drawback to medications is thatthe bedwetting typically returns when the medication is stopped.

What happens after treatment for the condition?

Once the child has regained control over his urination, theproblem is generally resolved. However, factors such as stress or another urinary tract infection may causeanother episode of enuresis.

How is the condition monitored?

Any new or worsening symptoms should be reported to the healthcareprovider.