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 and more
of these are boys than girls.
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.
Disorders main features are:
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
I t 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
Associated
Features:
Although the
great majority of children with Functional Enuresis do not have
a coexisting mental disorders, the prevalence of coexisting mental
disorders is greater in those with Functional Enuresis than in
the general population. Functional Encopresis,
Sleepwalking Disorder,
and Sleep Terror Disorder
may also be present. Other
associated features may include:
Limited
Social Interaction.
Lower Self-Esteem.
Rejection by Peers.
Anger/Punishment by Parents.
Behavior Problems/Conduct Problems.
Underachievement in School.
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.
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.
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
Behavioral&
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.
