Alternative Names bedwetting, bladder incontinence, loss of bladder control, uncontrollable urination
Definition Enuresis is the intentional or involuntary voiding of urine into clothes or other inappropriate places by a child at least 5 years old. The frequency must be at least twice or more a week for three months. There is no physical disorder. Primary enuresis is when bladder control has never been achieved. Secondary enuresis is when bladder control has been achieved for at least one year but has been lost. Enuresis may occur only at night, only in the day or during both day and night. Night time enuresis is the most common.
What are the causes and risks of the condition? Causes are usually psychosocial and physiologic. Children with enuresis often have other developmental delays. They tend to have smaller bladders, immature bone-age scores, and a higher likelihood of a learning disability. A link between enuresis and a sleep disorder may be involved. There is no clear proof of this. Genetics plays a role. Having one enuretic parent increases the chance of the child having enuresis by 45 percent. Having two enuretic parents increases the risk to 75 percent. About twice as many males are enuretic than females. 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 who are very controlling and fault-finding may also trigger problems with bladder control.
Medical causes of enuresis include:
urinary tract infection
diabetes mellitus and insipidus
constipation
ectopic ureter
lower urinary tract obstruction
neurogenic bladder
bladder calculi
epilepsy
sleep apnoea (due to enlarged adenoids)
What can be done to prevent the condition? There is no way to prevent enuresis caused by problems with development or anatomy. Parenting problems can be corrected. Not starting toilet training too early is important. When toilet training does begin, there should not be pressure or criticism of the child. Helping children prepare for stressful events can help prevent enuretic episodes in reaction to stress.
How is the condition diagnosed? A doctor will conduct a thorough physical examination. This will check for any physical causes. A complete medical, developmental and psychosocial history should be done. This will see what factors may be contributing to the problem. A urinalysis or x-ray might be needed.
What are the long-term effects of the condition? If not treated, the child may have negative social and psychological effects.
What are the treatments for the condition? Treatment falls into three categories. These are behavioural, medication and counselling. Usually more than one treatment is used at a time.
Behavioural treatment includes:
conditioning methods, such as using a bedwetting alarms that awakens the child if it gets wet
behavioural rewards for achieving bladder control
bladder training exercises to gradually increase the size of the bladder, along with encouraging postponing urination
decreasing evening fluids
teach the child to attend and respond to nocturnal bladder sensations
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 to function or only for special occasions. One drug, a nasal spray, decreases urine production during the night.
Counselling alone is rarely effective. A behavioural treatment regime needs to be established. Managing family stress and tension is important.
What are the side effects of the treatments? Some medications can cause cardiac problems in some children. One drawback to medications is that the bedwetting typically returns when the medication is stopped.
Author: Terry Mason, MPH Reviewer: HealthAnswers Australia Medical Review Panel Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia Last Updated: 1/10/2001 Contributors Potential conflict of interest information for reviewers available on request
