ENURESIS: CAUSES, INCIDENCE, AND RISK FACTORS

Children vary in the age at which they are physically ready to have complete control over their bladders. Many children are not ready for toilet training before the age of 3. Enuresis usually does not indicate an emotional or physical problem. It is twice as common among boys as girls. Causes may be due to a maturational delay in the development of bladder musculature and its ability to withstand the pressure of a large urine volume. It may also be related to toilet training that occurred too early or was too coercive. It may also be a symptom of temporary regression, a response to parents who are too controlling or critical, or as a problem of adjustment. Physical causes are rare, but may include lower spinal cord lesions, congenital malformations of the genitourinary tract, infections of the urinary tract, or diabetes. Risk factors are related to the causes.

Prevention:

Avoid initiation of toilet training before the child is ready.

Symptoms:

Involuntary urination, usually at night, occurs twice per month or more often.

Signs and tests:

A physical examination may be performed to rule out physical causes.

Laboratory tests (such as a urinalysis or urine culture) or X-rays may be performed to rule out certain possible causes of the symptoms, including urinary tract infection. Catheterization for residual urine amount may be performed.

Treatment:

A supportive, helpful attitude by the parents and/or care givers is very important.

The following methods may be helpful:

• behaviour modification techniques such as rewards for good behaviour
• limiting fluids at bedtime
• alarm devices to wake a child periodically or a bell alarm pad that awakens the child when the pad gets wet

If the cause of the disorder is emotional, psychotherapy is the recommended treatment. Psychotherapy can also help the child deal with the associated shame.

Expectations (prognosis):

The condition poses no threat to the health of the child if there is no physical cause of enuresis. The child may feel embarrassment or have a loss of self-esteem associated with the problem. Most children respond to some type of treatment.

Complications:

Complications may develop if a physical cause of the disorder is overlooked. Psychosocial complications may arise if the problem is not dealt with effectively and in a timely manner.