Enuresis What is enuresis?

Enuresis is a disorder of elimination that involves the voluntary or involuntary release of urine into bedding, clothing, or other inappropriate places. Involuntary enuresis is much more common than voluntary enuresis. Involuntary enuresis may be categorized as either primary or secondary. Unlike involuntary enuresis, voluntary enuresis is not common. It is associated with such psychiatric disorders as oppositional defiant disorder and is substantially different from ordinary nighttime bed-wetting. Voluntary enuresis is always secondary. When bedwetting occurs at night time, it is referred to as nocturnal enuresis. When it occurs in the day time it is referred to as diurnal enuresis. Types There are two main types of enuresis in children: Primary enuresis: Primary enuresis occurs when young children lack bladder control from infancy. Most of these children have urine control problems only during sleep; they do not consciously, intentionally, or maliciously wet the bed. Research suggests that children who are nighttime-only bed wetters may have a nervous system that is slow to process the feeling of a full bladder. Consequently, these children do not wake up in time to relieve themselves. In other cases, the child's enuresis may be related to a sleep disorder. Several studies have investigated the association of primary enuresis and psychiatric or behavior problems. The results suggest that primary nocturnal enuresis is not caused by psychological disorders. Bed-wetting runs in families, however, and there is strong evidence of a genetic component to involuntary enuresis.

Secondary enuresis: Secondary enuresis occurs when a child has stayed dry day and night for at least six months, then returns to wetting. Secondary enuresis usually occurs at night (nocturnal enuresis). Many studies have been done to determine if there is a psychological component to enuresis. Researchers have found that secondary enuresis is more likely to occur after a child has experienced a stressful life event such as the birth of a sibling, divorce or death of a parent, or moving to a new house.

Symptoms The symptoms of enuresis are urination at inappropriate times or inappropriate places. Diagnosing enuresis To be diagnosed with enuresis, a person must be at least five years old or have reached a developmental age of five years. Below this age, problems with bladder control are considered normal. Inappropriate urination must occur at least twice a week for three months; or the frequency of inappropriate urination must cause significant distress and interfere with the child's school and/or social life. Finally, the behavior cannot be caused exclusively by a medical condition or as a side effect of medication. In adults, loss of bladder control is often referred to as urinary incontinence rather than enuresis; it is frequently found in patients with late-stage Alzheimer's disease or other forms of dementia. Treatment for nocturnal enuresis: What not to do: punishing the child. What to do: Treatment for enuresis is not always necessary. About 15% of children who have enuresis outgrow it each year after age six. When treatment is desired, a physician will rule out obvious physical causes of enuresis through a physical examination and medical history. Several different treatment options are then available: You should reassure your child that bedwetting is common and can be helped. Start by making sure that your child goes to the bathroom at normal times during the day and evening and does not hold urine for long periods of time. Be sure that the child goes to the bathroom before going to sleep. You can reduce the amount of fluid the child drinks a few hours before bedtime, but this alone is not a treatment for bedwetting. You should not restrict fluids excessively. Reward your child for dry nights. Some families use a chart or diary that the child can mark each morning. While this is unlikely to solve the problem completely, it can help and should be tried before medicines are used. It is most useful in younger children, about 5 to 8 years old.

 Bedwetting alarms are another method that can be used along with reward systems. The alarms are small and readily available without a prescription at many stores. The alarm wakes the child or parent when the child starts to urinate, so the child can get up and use the bathroom. Alarm training can take several months to work properly. You may need to train your child more than once. Bedwetting alarms have a high success rate if used consistently. Once your child is dry for 3 weeks, continue using the alarm for another 2 weeks and then stop. A prescription medication called DDAVP (desmopressin) is available to treat bedwetting. It will decrease the amount of urine produced at night. DDAVP is easy to use and provides quick results. It can be used shortterm for an important sleepover, or prescribed for long-term use for months. Your doctor may recommend stopping the medicine at different times to see if the bedwetting has gone away. Tricyclic antidepressants (most often imipramine) can also help with bedwetting. However, side effects can be bothersome, and an overdose can be life-threatening. Therefore, these drugs are usually used when other treatments have failed. Some sources find that bedwetting alarms combined with medicine results in the highest number of cures. Secondary enuresis, however, is often successfully treated with therapy. The goal of the treatment is to resolve the underlying stressful event that has caused a relapse into bed-wetting. Unlike children with involuntary enuresis, children who intentionally urinate in inappropriate places often have other serious psychiatric disorders. Enuresis is usually a symptom of another disorder. Therapy to treat the underlying disorder is essential to resolving the enuresis. Prognosis Enuresis is a disorder that most children outgrow. For those who do receive treatment, the overall success rate of behavioral therapy is 75%. The short-term success rate with drug treatments is even higher than with behavioral therapy. Drugs do not, however, eliminate the enuresis. Many children who take drugs to control their bed-wetting relapse when the drugs are stopped. Prevention Although enuresis cannot be prevented, one side effect of the disorder is the shame and social embarrassment it causes. Children who wet may avoid sleepovers, camp, and other activities where their bed-wetting will become obvious. Loss of these opportunities can cause a loss of self-esteem, social isolation, and adjustment problems. A kind, low-key approach to enuresis helps to prevent these problems.

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