Involuntary urination in children over 5 to 6 years old. It usually occurs at night. (See also incontinence .)
Causes, incidence, and risk factors
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. It is more than twice as common among boys as girls. Causes may be due to a maturational delay in the development of bladder musculature and its ability to withstand the pressure of a large urine volume . It may also be related to toilet training that occurred too early or was too coercive. It may also be a symptom of temporary regression, a response to a new situation, to parents who are too controlling or critical, or as a problem of adjustment. Physical causes are rare, but may include lower spinal cord lesions , congenital malformations of the genitourinary tract, infections of the urinary tract, or diabetes . Risk factors are related to the causes. At age 5 about 7 in 100 boys and 3 in one hundred girls have bed wetting problems. The percentages decrease rapidly after age 5 years. Risk factors include a family history of bed wetting.
Signs and tests
A physical examination may be performed to rule out physical causes. A urinalysis is indicated to rule out infection or diabetes. X-rays of the kidneys and bladders and more invasive studies are not indicated unless there is reason to suspect some other problems.
Treatment
Time and patience are the parent's greatest allies. Indeed, the spontaneous cure rate is 15% per year. A supportive, helpful attitude by the parents and/or care givers is very important. The following methods may be helpful:
behavior modification techniques such as rewards for remaining dry at night (the rewards increase in value as the number of consecutive dry nights increase limiting fluids at bedtime (to be effective fluid limitation must be started after dinner but may be difficult to enforce and hard on young children alarm devices to wake a child periodically or a bell alarm pad that awakens the child when the pad gets wet 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. Desmopressin (DDAVPa medication that is an analogue of the hormone vasopressin -- see the vasopressin test for more information about this hormone) may also be prescribed to reduce urine production throughout the night. DDAVP is effective but more expensive than imipramine. If the cause of the disorder appears to be emotional, family counseling may provide insights into the problem and recommend appropriate approaches to therapy.
Expectations (prognosis)
The condition poses no threat to the health of the child if there is no physical cause of enuresis. The child may feel embarrassment or have a loss of self-esteem associated with the problem. Most children respond to some type of treatment.
Complications
Complications may develop if a physical cause of the disorder is overlooked. Psychosocial complications may arise if the problem is not dealt with effectively and in a timely manner.
Calling your health care provider
Call for an appointment with your child's health care provider if bed wetting occurs (to rule out urinary tract infection or other causes).
Prevention
Avoid initiation of toilet training before the child is ready.