Enuresis

Enuresis is the medical term used to describe the involuntary discharge of urine
beyond the age when a child is old enough to be able to control urination (usually
considered to be six years of age for nighttime control), or more commonly, bedwetting.
There are several types of enuresis: diurnal enuresis is wetting that occurs during waking
hours, primary nocturnal enuresis is a lack of the achievement of total bladder control
during sleep, and secondary nocturnal enuresis is loss of bladder control that happens
after a child (or adult) has been dry a night for a long period of time (usually three to six
months). The facts, causes, and treatments of this disorder can help bring a greater
awareness and understanding of enuresis.
Nocturnal enuresis is a common problem. It is estimated that there are five to
seven million children in the United States who have NE. Many children have no lasting
problems from bed-wetting, however, some children who wet the bed can develop
psychological problems, including low self-esteem. This disorder also affects family
members through anger and frustration because of the condition.


One important reminder to parents with children who suffer from this condition is
that bed-wetting should not be thought of as a behavioral problem. There is no medical
proof to show that children wet the bed to spite their parents. Also, most children will
outgrow bed-wetting eventually. As parents, the best way to help your child is to be
understanding and remember that punishing or making fun of a child who wets the bed
can only make the situation worse.
Though as of yet a cause is unknown, some doctors believe that children who wet
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the bed might have small bladders or be such deep sleepers that the urge to urinate does
not wake them up. Of course, some research has proven that some children with NE
have normal-size bladders and have normal sleep patterns. What is known is that bed-
wetting is not a mental problem, a learning problem, or a behavioral problem. Though if
a child is punished in any way from the bed-wetting, psychological problems can arise.
Recent medical research, however, has found that many children with NE may have a
deficiency during sleep of an important hormone known as antidiuretic hormone (ADH).
ADH helps to concentrate urine during sleep hours–meaning that the urine contains less
water and is therefore of decreased volume. This decreased volume usually means that
their bladders do not overfill while they are asleep unless the child has had an excessive
quantity of fluids before bed. Testing has shown that many of these children do not show
the usual increase in ADH during sleep. Children with enuresis, therefore, often produce
more urine during hours of sleep that their bladders can hold. If they do not wake up, the
bladder releases the urine and the child wets the bed.
There are many successful treatments for bed-wetting. Some doctors recommend
bladder control exercises to help stretch and condition your child’s bladder and help him
or her to become more aware of bladder control as a part of learning to stay dry. These
exercises include learning to resist the immediate urge to urinate, in order to increase the
bladder size, and stopping urine flow midstream to strengthen bladder muscles.
Changing the child’s eating and drinking habits throughout the day and at bedtime may
also be recommended.
“Night-lifting” is a procedure that involves waking the child periodically
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throughout the night, walking the child to the bathroom to urinate, and then returning the
child to bed. The desired effect from this procedure is that the child will learn to awaken
and urinate many times during the night.

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Moisture alarms is a treatment that requires a supportive and helpful family and
may take many weeks or even several months to work. Moisture alarms have good long-
term success and fewer relapses that medications. Alarms usually consist of a clip-on
sensor probe that attaches to the outside of bed-clothing. An alarm is set off when the
child begins to wet the bed. This alarm should wake the child, who will then go to the
bathroom to finish the urination before going back to sleep. If the child does not wake
up, the parent should help them to the bathroom
Hypnosis is another approach to the treatment of bed-wetting that is being used
successfully by doctors. Hypnosis is less expensive, less time-consuming, and less
dangerous than most approaches, because it has virtually no side effects. Because
hypnosis can give the child the power to treat themselves, this form of therapy can also
help build the child’s self-confidence and self-esteem as well as help with the bed-
wetting.
Some medications have also been used for this disorder. Antidepressants, for
example, have been used to suppress the urge, but not on a long-term basis. Imipramine
has been successful for approximately 30% of children. However, antidepressants are
powerful drugs and some can have serious side effects, especially in children.
Desmopressin acetate is a man-made form of antidiuretic hormone that works by
substituting for the natural hormone. It helps the child’s body make less urine, and thus
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lessens the risk that the child’s bladder will overflow during sleep. It is usually given in a
nasal spray form. Few side effects have been reported but some that have been noted are
headaches, runny nose, pain in the nostrils, and nasal stuffiness. It can also work quickly,
some after even the first dosage, but it is recommended for use for three months. It is in
some cases not a long-term substitute but restarting the dosage can be prescribed by a
doctor.
Enuresis is a very serious disorder for young children. It is sometimes seen as the
result of too much to drink before bedtime or the result of bad dreams, but is not.
Enuresis is a medical problem that, if not properly diagnosed and treated, can have
adverse consequences. These include loss of self-esteem for the child and psychological
distress for the child and the family. The National Kidney Foundation maintains a
physician referral service of physicians nationwide who have indicated an interest in
caring for patients with bed-wetting. This referral service can be reached at 1-800-622-
9010. Also, the National Enuresis Society can be reached via mail at 7777 Forest Lane
Suite C-737, Dallas, TX 75230-2518. Their foundation is dedicated to building greater
understanding of enuresis and can help with any problem relating to child enuresis.