Enuresis

Bed-wetting, a disorder of elimination that involves the voluntary or involuntary release of urine into bedding, clothing, or other inappropriate places.

The repeated voiding of urine into bed or clothes in children at least 5 years old, not due to any general medical condition. May be associated with various psychosocial factors, such as early childhood hospitalization, the birth of a younger sibling, or serious trauma.

Nocturnal and daytime incontinence of urine.

The involuntary discharge of urine after the age of 3.

The involuntary passing of urine.

Enuresis is a disorder that involves accidental urination after the age of 5 years. Enuresis can more specifically be described as occurring during the day only (diurnal), the night only (nocturnal), or both (mixed). Some clinicians also differentiate between primary (no period of continence has ever been achieved) and secondary (incontinence following a period of at least 6 months of continence). Some question the clinical utility of this distinction, as treatment outcome does not differentiate type. Although the etiology of enuresis remains unclear, the two most strongly supported etiologic theories for nocturnal enuresis are (a) a deficiency in nocturnal secretion of antidiuretic hormone (ADH) and (b) failure to contract pelvic floor muscles during sleep. For a minority of children, other physiological issues may be involved in enuresis. These include urinary tract infections, urinary tract anomalies, low functional bladder capacity (FBC), constipation, diabetes mellitus, and family history of enuresis. Physiological causes are more prevalent among children with diurnal enuresis. Although psychological problems have been offered as causes of enuresis, few data support this view. Children with nocturnal enuresis may have problems with anxiety or low self-esteem, but the nature of the relationship appears correlational rather than causal. Stress does appear to be a factor in some cases of secondary enuresis.

Inability to exercise full control of urination, especially during the night but also sometimes during the day; a term generally referring to otherwise normal children of school age, younger children being seen as still developing control. (By contrast, children who have physical disorders, such as spina bifida or paralysis, that prevent them from exercising control are said to have incontinence.)

Passing of urine without control, especially during sleep (bedwetting). The condition can be caused by a urinary tract disorder but is usually a childhood phenomenon that is outgrown. Restriction of fluids, especially near bedtime, and the use of a device that rings a bell to awaken the child when urination begins are sometimes helpful.

Involuntary nighttime bed-wetting, particularly in children.

The involuntary passing of urine, especially bedwetting at night (nocturnal enuresis). This can be caused by underlying disorders of the urinary tract but is usually functional in nature. The condition settles spontaneously as the child grows older, but it may persist into teenage, and rarely adult, life. The condition can be treated successfully by fluid restriction, various drugs, or use of a nocturnal alarm.

Bed-wetting, or the involuntary passage of urine at night. It can occur at all ages but is a particular problem with children and the elderly. In general, paediatricians prefer not to treat enuresis much before the age of six, as it may be a normal phenomenon and usually stops as the child grows older. However, when the condition persists, the child and parents need advice. Treatment is by positive reinforcement of bladder control, alarm systems such as the ‘pad and bell’, or occasionally by drugs such as Desmopressin, which reduces night-time urinary output. Some children have an ‘irritable bladder’ and can be helped by drugs which relieve this. Enuresis is often a result of psychological disturbance, particularly where family relationships are disrupted. In this circumstance medication is unlikely to be effective.

Involuntary discharge of urine after the age at which bladder control should have been established. In children, voluntary control of urination is usually present by 5 years of age. Nevertheless, nocturnal enuresis is present in about 10% of otherwise healthy 5-year-old children and 1% of normal 15-year-old children. Enuresis is slightly more common in boys than in girls and occurs more frequently in firstborn children. This condition has a distinct family tendency.