Enuresis: Symptoms, Causes
and Treatment

The word enuresis is derived from a Greek word that means "to make water." In North America, the term is used to refer to involuntary discharge of urine by night or day. Primary enuresis refers to inability to maintain urinary control from infancy. Secondary enuresis is a relapse after control has been achieved.

SYMPTOMS:

It is called enuresis after the age by which bladder control should have been established. In children, voluntary control of urination is usually present by the age of five. Nevertheless, nocturnal enuresis is present in about 15 to 20 percent of otherwise healthy 5-year-old children, 7 percent of healthy 7-year-olds, 5 percent of healthy 10-year-olds, 2 to 3 percent of 12 to 14-year-olds and 1 to 2 percent of normal children at age 15.

Enuresis is slightly more common in boys than in girls and occurs more frequently in the first born child.

CAUSES:

A number of things can cause enuresis. Some of the more common causes of bed-wetting include the following:

• Genetic factors (it tends to run in families)
• Difficulties waking up from sleep
• Stress
• Slower than normal development of the central nervous system (which reduces the child's ability to stop the bladder from emptying at night)
• Hormonal factors (not enough antidiuretic hormone is produced, which is the hormone that slows urine production at night)
• Urinary tract infections
• Abnormalities in the urethral valves in boys or in the ureter in girls or boys
• Abnormalities in the spinal cord
• A small bladder

TREATMENT:

The goals of treatment are to reduce the social and psychological impact of the condition and to eliminate the underlying cause. Treatments include the following:

• Behavior modification (e.g. positive reinforcement, periodic waking, restricted fluid intake, alarm therapy)
• Medication
• Surgery (in cases of obstructive sleep apnea, ectopic ureter, heart block)