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:
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).
Nocturnal and Diurnal
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,
and Sleep Terror Disorder
may also be present. Other
associated features may include:
Rejection by Peers.
Anger/Punishment by Parents.
Behavior Problems/Conduct Problems.
Underachievement in School.
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.
medical problems particularly urinary or bladder infections.
have a number of causes which can include the effects of internal
marital disputes, fear, lack of self confidence and medical problems.
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.
your child calmly about the problem can sometimes uncover fears
Behavior modification techniques such as rewards for remaining
dry at night (the rewards increase in value as the number of consecutive
dry nights increase
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
Enuresis alarm or buzzer
[ See Psychopharmacology
Section ] :
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.