Enuresis

Enuresis is a disorder characterized by urinary incontinence in children five years old and up.  Though it’s commonly called bedwetting, the disorder encompasses any abnormal urinary voiding that occurs, day or night.  Some children with enuresis may not notice that they need to go to the bathroom.  Others may realize that they need to urinate but then become distracted and forget until it is too late.  While most children outgrow enuresis, the disorder can cause them great embarrassment and may create a strain on the whole family. Fortunately, effective behavioral and pharmacological treatment is widely available.

It is common for young children to have poor bladder control.  However, you might begin to worry if your child is 5 or older and experiences urinary incontinence on a regular basis, especially if this behavior is new; while this isn’t terribly uncommon up to age 7, it can of course be problematic. Children with enuresis are frequently very heavy sleepers and may not notice that they are wetting the bed.  Your child may describe himself as too tired to go to the bathroom or too involved in play or other activities to stop. 

Enuresis frequently runs in families.  A child has an 80% chance of developing the disorder if both of his parents had enuresis. It might also be caused by a small bladder, a hormone imbalance, or chronic constipation.  Stressful events may also be a trigger.  The disorder is more common among boys and children with ADHD.

Enuresis is diagnosed in children who are at least 5 years old and experience urinary incontinence, whether during the day or at night, involuntary or intentional. It’s considered enuresis if it occurs fairly regularly for an extended period, or if it is creating problems for him in school or social environments. Before a diagnosis is made your child’s clinician will perform a physical exam to make sure that he is not suffering from a urinary tract infection, diabetes, or another medical condition that produces similar symptoms.

Most cases of enuresis are treated through behavioral therapy, although in some cases medication may be prescribed.

 

Psychotherapeutic: An experienced clinician can work with you to craft a behavioral approach. There are several options, among them moisture alarms—sensors that detect moisture and will wake your child whenever he begins to wet the bed—that have proven extremely effective in treating enuresis, though they may take several weeks. Other options may include limiting liquid and caffeine intake at night, encouraging frequent urination, and rewarding your child for each night without bedwetting.

 

Pharmacological:  There are some medical options for treating enuresis, but they only work in the short-term; when the child stops taking the medicine he will resume wetting his bed. Desmopressin, which can be taken in a pill or nasal-spray form, causes less urine to be produced at night.  If your child has a small bladder, another option might be Ditropan or Levinsin, which increases bladder capacity and decreases bladder contractions.

Will my child outgrow it?
Most children will grow out of enuresis. But because the acute embarrassment it causes can be very painful for a child, it’s a good idea to seek treatment.
Do drugs help?
Drugs will help your child stop wetting the bed, although they will not provide a long-term solution to the disorder. Most doctors favor treating enuresis with behavioral therapy, though in some cases they may also prescribe medicine.
What causes it?
There may be a genetic factor—if there is a family history of bedwetting, your child will be much more likely to develop the disorder. Other factors might include a small bladder, hormone imbalance, a stressful event such as divorce, or inadequate toilet training.
How long does it take for the moisture alarm to become effective?
You may begin to see a response after two weeks, or sooner. But it is important not to discontinue using the alarm before the treatment is complete—a child who has been dry for a week might still have a relapse.