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.
