A PARENT’S GUIDE TO ENURESIS

What is enuresis?
Normal urinary control is usually established by 3 to 4 years of age. Lack of voluntary urinary control (wetting) in a child beyond 5 years of age is called enuresis. When this occurs only when the child is sleeping (bed-wetting), the condition is called sleep enuresis (or nocturnal enuresis)

Is enuresis common?
Yes. Approximately 15 to 20 of every 100 healthy children still wet the bed while sleeping at 5years of age, and approximately 5% to 10% of children still wet the bed while sleeping at 10 years of age.

What causes enuresis?
While there are many theories, the exact etiology of enuresis is unknown. In most children, enuresis represents a delay in the normal process of developing bladder control. With some children, there is a strong family history of sleep enuresis, which may play an important role. A small percentage of children have an anatomic abnormality of the urinary tract that is responsible for their poor bladder control.

Does my child need to see a doctor?
Yes. All children with enuresis should have a physical examination and a urinalysis. When the examination is entirely normal and the child has not had a urinary tract infection (UTI), additional testing is typically unnecessary.

Does my child have a serious physical problem?
Only a small percentage of enuretic children have a physical problem with their bladder or kidneys. These children usually have had a UTI or have bladder control problems both day and night (or both). Children who wet the bed only while asleep and who urinate normally during the day rarely have a physically problem.

Does my child need x-ray studies?
Kidney and bladder x-rays are typically unnecessary, and are usually performed only when there is a history of UTI or day and night wetting.

Does my child have an emotional problem?
Emotional stress is rarely the cause of enuresis. Children with an emotional problem usually have established normal urinary control for 6 months to a year or more, then subsequently lose control and start to wet again (a condition called secondary enuresis). Such children often have recent identifiable stress in their lives (such as moving, school change, death, divorce, or the birth of new siblings).

When a child has never established normal urinary control (so-called primary enuresis), it is uncommon that a psychological problem is to blame. Children with enuresis often feel shame, guilt and frustration, which may cause the subsequent development of emotional problems, are not the primary cause of enuresis, but instead, a result of the wetting. These problems can be minimised by giving these children appropriate support and understanding.

Does my child need treatment to cure the problem? Virtually all children eventually stop bed wetting spontaneously. Unfortunately, no one can tell you how long it will take for your child to reach that point. Approximately 20% of children cease wetting every year without treatment. Therefore, in the majority of cases, no treatment is necessary. The decision to treat a child should be made jointly by the family, patient, and physician. In general, treatment is considered for relatively older children, those with secondary emotional problems, and children with more severe that on universally accepted treatment of enuresis is 100% successful. Be wary of anyone who promises such a cure.

What treatments are available?
Treatment options can be divided into two basic categories: behavioural and pharmacologic therapies. Both types of treatment have been shown to be effective in many studies. In evaluating any claim of successful treatment, it is essential to remember that 15% to 20% of enuretic children improve spontaneously every year without treatment. Therefore, any treatment modality will have some “success”. Some enuresis centres take advantage of these fact and claim success rates that are scientifically valid. The question that should be asked is whether improvements are the result of a successful therapy or simply spontaneous cure.

Behavioural therapies. Behaviour modification programs typically consist of varying combinations of several components, including bladder training, positive reinforcement and the bell-and-pad alarm system. Most programs use an enuresis alarm and relatively labour intensive. These programs are most effective when the patient and the family are highly motivated and willing to participate. Health insurance policies sometimes cover the cost of enuresis alarms when they are prescribed by your physician.

Pharmacotherapy. Three medications are currently available for the treatment of enuresis. Tofranil (imipramine hydrochloride) is an oral medication taken daily to prevent bedwetting. It precise mechanism of action is unknown. DDAVP (desmopressin acetate) is a synthetic hormone, administered by nasal spray that prevents enuresis by decreasing the child’s urine output during the night. The third medication, Ditropan (oxybutynin chloride), is typically used to treat children with daytime wetting but is generally less helpful for those with pure sleep enuresis. As with all medication, these drugs have potential side success rates that must be understood before treatment is initiated. These medications must successful be kept out of the reach of small children to avoid serious overdose.

What can families do for their enuretic children?
An important first step is to reassure the child that enuresis is usually temporary and very common. This will help minimise the emotional problems for the child. It is also important that parents understand that while wetting usually resolves in time, emotional problems resulting from enuresis may continue for years. Other simple steps that may help: