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Refer to conditions of use

Enuresis

It has been estimated that in the United Kingdom over half a million children between the ages of 6 and 16 years regularly wet the bed. More of these are boys than girls. It is very easy for children to feel that they are the only ones with the problem, as it is not something that is easy to reveal and share with friends. Children vary in the age at which they are physically ready to have complete control over their bladders. Many children are not ready for toilet training before the age of 3. Enuresis usually does not indicate an emotional or physical problem but can do.

Accidentally or on purpose, the patient repeatedly urinates into clothing or the bed.

The clinical importance of this behavior is shown by either:

* It occurs at least twice a week for at least 3 consecutive months or
* It causes clinically important distress or impairs work (scholastic), social or personal functioning

The patient is at least 5 years old (or the developmental equivalent).

This behavior is not directly caused by a general medical condition (such as diabetes, seizures,
      spina bifida) or by the use of a substance (such as a diuretic).


Specify type:

Nocturnal Only
Diurnal Only
Nocturnal and Diurnal

Differential Diagnosis 

Some disorders have similar or even the same symptoms. The clinician, therefore, in his/her diagnostic attempt has to differentiate against the following disorders which need to be ruled out to establish a precise diagnosis.

 Current medical problems particularly urinary or bladder infections.

Cause:

Enuresis may have a number of causes which can include the effects of internal marital disputes, fear, lack of self confidence and medical problems. Bedwetting (or nocturnal enuresis) is said to be present when a child over the age of five wets the bed at least once a month with no congenital (inborn) abnormalities or underlying health problems causing the bedwetting. Nocturnal enuresis is divided into two types: primary and secondary. Primary nocturnal enuresis is when bladder control has never been gained, secondary nocturnal enuresis is when bladder control has been gained for at least 6 months and then lost.

Treatment:

The treatment of enuresis can take a multiple approach; parental understanding, possible through counseling for the parent and psychotherapy for the child, to mechanical and behavioral devices employed to assist in braking the bedwetting cycle.

Counseling and Psychotherapy [ See Counseling Section ]:

Talking to your child calmly about the problem can sometimes uncover fears or anxieties. Behavior modification techniques such as rewards for remaining dry at night (the rewards increase in value as the number of consecutive dry nights increase

Behavioural & Other:

* Night-time Protection Pants
* Ensure easy access to the toilet at night
* Encourage a good level of fluid intake throughout the day
* Encourage small steps, such as going to the toilet before bed without prompting
* Enuresis alarm or buzzer


Pharmacotherapy [ See Psychopharmacology Section ] :

In older children, imipramine may be prescribed, but close observation of the child's response to medication must be maintained. Imipramine may begin to work by the first or second night. Treatment usually lasts 4 to 6 months.

See Also Our Behaviour Disorders Links Page