Enuresis

Enuresis is involuntary urination, especially by children at night. Voluntary, or intentional, enuresis may be associated with other mental disorders, including behavior disorders or emotional disorders such as anxiety.

BRIEF SUMMARY

Enuresis is involuntary urination, especially by children at night. Voluntary, or intentional, enuresis may be associated with other mental disorders, including behavior disorders or emotional disorders such as anxiety. Involuntary urination is also known as urinary incontinence and may also be referred to as “bedwetting”. Nocturnal enuresis is involuntary urination that happens at night while sleeping, after the age when a person should be able to control his or her bladder. (Involuntary urination that happens during the day is known as diurnal enuresis.) There are two kinds of enuresis: primary and secondary. Someone with primary nocturnal enuresis has wet the bed since he or she was a baby (primary nocturnal enuresis is the most common form). Secondary enuresis is a condition that develops at least 6 months — or even several years — after a person has learned to control his or her bladder.

Enuresis is also occasionally associated with neurological disorders, such as Tourette’s syndrome, particularly in children. Nighttime (nocturnal) enuresis may be related to any of the above, or may be a symptom of a sleep disorder. Treatment options include regularly scheduled toileting, increasing awareness of the need to urinate, exercises intended to strengthen the muscles that control release of urine (see Kegel exercises), pads and in some cases special devices that alert the patient to initial signs of wetness. Cognitive behavioral therapy or behavior modification techniques can be helpful. Prescription medication, most often desmopressin (a tablet) can also be helpful in certain circumstances in children over the age of 5.

KEY POINTS

  • Approximately 5% to 10% of all seven-year-olds have enuresis, and an estimated 5 to 7 million children in the United States have enuresis.
  • Doctor’s don’t always know the exact cause of enuresis, but they theorize that the following can be contributing factors: hormonal problems, bladder problems, genetics, sleep problems, caffeine, medical conditions, and psychological problems.
  • Enuresis is more common in males than females.
  • It is often associated with ADHD.
  • The good news is that it’s likely that bedwetting will go away on its own. In fact, 15 out of 100 kids who wet the bed will stop every year without any treatment at all.
  • 2% to 3% of children have symptoms into adulthood.
  • Primary nocturnal enuresis almost always resolves spontaneously over time. Treatment should be delayed until the child is able and willing to adhere to the treatment program; medications are rarely indicated in children younger than seven years. If the condition is not distressing to the child, treatment is not needed. However, parents should be reassured about their child’s physical and emotional health and counseled about eliminating guilt, shame, and punishment.
  • Enuresis alarms are effective in children with primary nocturnal enuresis and should be considered for older, motivated children from cooperative families when behavioral measures are unsuccessful.

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