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Enuresis involves involuntary urination in any child greater than five to six years old. It can occur in the daytime or the nighttime. Most problems with enuresis occur during sleep-at night time. If it happens during the day, it is usually called incontinence.

The causes of enuresis can simply be an immature bladder or neurological system. Night time dryness is generally the last part of learning to use the toilet. If the child cannot stay dry during the night more than twice a month, the condition is called nocturnal enuresis or bed-wetting.

Children who were never dry at night have primary enuresis. Children who have been dry for about six months or more but wet the bed after that have secondary enuresis. The problem can be a physical problem, an emotional problem or simply a change in sleep patterns. Primary enuresis generally occurs when the body makes more urine during the night than the bladder can actually hold. The child does not awaken when the bladder is full and the bladder is stimulated to empty. Rarely there are physical causes for enuresis. It may be caused by lower spinal cord injury, malformations of the urinary tract, bladder infections or diabetic conditions. Bed-wetting also tends to run in families.

Enuresis occurs in about nine percent of boys by the age of seven and in about six percent of girls. The number of patients with enuresis gradually decreases over time but there are still teens and even adults who have residual enuresis.

The symptoms of enuresis involve involuntary urination during the night that occurs about twice per month or more. It can occur every night. The patient may wake up after urinating or during urinating, but they may not wake up at all.

Doctors will diagnose enuresis by taking a complete history and determining what the urination patterns have been in the case of a child with potential bed-wetting. The doctor will ask about food and fluid intake before bedtime and when the child sleeps. An examination and urinalysis will be done to make sure there is nothing physically wrong that can be picked up on physical examination or lab testing. It is not necessary to do x-rays of the kidneys and bladder as it is an often normal test.

Treatment of enuresis or bed-wetting involves many things. Some parents choose to do nothing, while others punish their child, both wrong ways to handle the situation. Parents need to make sure that the child goes to the bathroom before sleeping and doesn't drink a lot before bedtime. Reward the child whenever there are dry nights and keep track of dry nights on a calendar or diary. There are bed-wetting alarms that warn the child to wake up as soon as he or she is voiding. The child can then get up and use the bathroom. Bed-wetting alarms work well for some children and tend to work over several weeks. If the child is dry for three weeks, use the bed-wetting alarm for another two weeks and then discontinue it.

There is a prescription medication known as DDAVP or desmopressin. It is a nasal spray that, when taken at night, works to decrease the amount of urine made during the night. It provides quick results in children who use it. You can use it regularly for awhile and then discontinue it to see if the child is now dry at night. Antidepressant medication, such as tricyclic antidepressants (especially imipramine) prevents wetness at night. The best cure comes from a combination of a bed-wetting alarm and medications.

The outlook of enuresis is good. Some children develop emotional problems because of their having enuresis and some lose self esteem. Most children recover completely with or without treatment as their neurological system matures.

HELPLINE: ☎ 1800 633 634

HELPLINE: ☎ 1800 633 634

The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here