Enuresis is a pattern of involuntary discharge of urine by a child age 5 and over. It can be psychologically stressful and a source of embarrassment for a child, but not physically harmful. Enuresis puts a child at risk of being a target for name-calling and teasing from peers, which can damage a child's self-esteem and place him or her at risk of rejection. The presence of enuresis can place a limit on participation in highly desirable social experiences such as sleepovers and summer camp. The child may also have to face anger and humiliation from parents who do not understand the nature of this disorder.
The history is essential in making the proper diagnosis and should address the following:
- Hydration history
- Daytime voiding pattern
- Toilet training history
- Number and timing of episodes of bedwetting
- Behavior, personality, and emotional status
Alertness should be maintained for symptoms of common underlying problems such as the following:
- Overactive bladder or dysfunctional voiding
- Neurogenic bladder
- Sleep-disordered breathing
- Major motor seizure
Types of enuresis
There are two types of enuresis: primary and secondary. Someone with primary nocturnal enuresis has wet the bed since he or she was a baby. Secondary enuresis is a condition that develops at least 6 months, or even several years, after a person has learned to control his or her bladder.
Primary bed wetting is usually due to a delay in the maturation of the part of the nervous system that controls bladder function. Another cause for children who urinate during the night may be a deficiency of the antidiuretic hormone ADH. The presence of this hormone concentrates urine and prevents the bladder from filling up during sleep. Young children do not have a mature signaling mechanism between the bladder and the brain to become aware of a full bladder. Consequently, they fail to wake up and may wet their bed.
Secondary bed wetting may be due to either psychological problems or medical disorders, such as a urinary tract infection, urinary tract abnormalities, or diabetes. Psychosocial stress and delayed or lax toilet training can also cause enuresis.
In addition to doing a physical examination, the doctor will ask you about any concerns and symptoms you have, your past health, your family's health, any medications you're taking, any allergies you have, and some other issues. He or she may ask about sleep patterns, bowel habits, and urinary symptoms. Your doctor may also discuss any stressful situations that could be contributing to the problem.
Treatment techniques can include moisture alarm systems and dry bed training, which includes bladder training and medications. The alarm system attaches a moisture sensor attached to the child's pajamas and a small speaker to the shoulder of the child. A single drop of urine is sufficient to activate a piercing alarm that causes the child to tense so that he or she stops urinating. This alarm may not waken a child. If the child sleeps through the alarm, the parent then awakens and escorts him or her to the toilet.
If you're worried about enuresis, the best thing to do is talk to your doctor for ideas on how to cope with it. He can also give you tips on how to cope. The good news is that it's likely that bedwetting will go away on its own. In fact, 15 out of 100 kids who wet the bed will stop every year without any treatment at all.