Enuresis

DEFINATION:

Enuresis is the involuntary voiding of urine at least twice a month in a child age five or older. It is the involuntary discharge of urine during sleep, It is called bedwetting after the age by which bladder control should have been established.

EXPLANATION:

Children vary markedly in the age at which they are physiologically ready to awaken from sleep aware of the need to urinate. This hinders their ability to hold their urine throughout the night.  In children, voluntary control of urination is usually present by the age of five.

PREVALANCE: Although in 1 percent of cases, enuresis continues into adulthood, most children are continent by adolescence.

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

AGE OF ONSET: Age of onset varies,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.

ETIOLOGY: For most children, there is no disease that causes bedwetting, and a true organic cause is identified in only about 2 to 3 percent of children with the condition.

A number of factors may contribute to enuresis:

  • Genetic factors
  • A family history of enuresis
  • Delayed maturation
  • A stressful life event, such as the birth of a sibling, the first week of school or a parent’s going away
  • Delayed arousal from sleep
  • Small functional bladder capacity
  • Chronic constipation can irritate the bladder, which results in frequent urination.
  • Sleep apnea (periods of non-breathing during sleep) decreases oxygen levels. This may make a child less responsive to the sensation of a full bladder and less likely to wakeup when they need to urinate.
  • Urinary tract infection
  • High urine production during the night

CLASSIFICATION: Two different varieties of Enuresis are seen

  • primary enuresis: If the child has never been totally dry for a year, the condition is known as primary enuresis. Eighty-percent of children who wet their bed suffer from primary enuresis.
  • Secondary enuresis: Secondary enuresis is when a child has had a dry period of at least a year before the appearance of the problem. The child invariably urinates during the first third of the night and remembers nothing of the occurrence.

SIGNS AND SYMPTOMS: Aside from wet pajamas, enuresis itself causes no direct impairment of the child’s life, but social ostracism by peers (at sleepovers and camp, for example), and anger and rejection by parents can damage self-esteem.

PARENTS APPROACH TO DISORDER: If the child develops “new” bedwetting after having achieved night time dryness, you should consult with you physician. This could be a sign of anxiety or stress, diabetes, bladder infection or a seizure.

If you believe that family tension or problems are causing your child to develop bedwetting, discuss obtaining a referral for counseling for the family and your child for this problem.