Mental Health: Enuresis

What is Enuresis?

Enuresis is when a child has repeated passage of urine in places other than the toilet. Enuresis that occurs at night, or bed-wetting, is the most common type of elimination disorder. This behavior may or may not be purposeful. The condition is not diagnosed unless the child is 5 years or older.

Nocturnal enuresis is the passage of urine during nighttime sleep, while diurnal enuresis is daytime wetting. Children with enuresis may experience either nocturnal or diurnal wetting, or they may experience a combination of both.

What Are the Symptoms of Enuresis?

The main symptoms of enuresis include:

• Repeated bed-wetting.
• Wetting in the clothes.
• Wetting at least twice a week for approximately 3 months.

What Causes Enuresis?

Many factors may be involved in the development of enuresis. Involuntary, or non-intentional, release of urine may result from:

• A small bladder.
• Persistent urinary tract infections.
• Severe stress.
• Developmental delays that interfere with toilet training.

Voluntary, or intentional, enuresis may be associated with other mental disorders, including behavior disorders or emotional disorders including anxiety. Enuresis also appears to run in families, which suggests that a tendency for the disorder may be inherited (passed on from parent to child). In addition, toilet training that was forced or started when the child was too young may be a factor in the development of the disorder. Currently, however, there is little research to make firm conclusions about the role of firm or lax toilet training regimens in the development of enuresis. Children with enuresis are often described as heavy sleepers who fail to awaken at the urinary urge to void or when their bladders are full.

How Common Is Enuresis?

Enuresis is a common childhood problem. Estimates suggest that 7% of boys and 3% of girls age 5 have enuresis. These numbers drop to 3% of boys and 2% of girls by age 10. Most children outgrow this problem by the time they become teens, with only about 1% of males and less than 1% of females having the disorder at age 18.

How Is Enuresis Diagnosed?

First, the doctor will take a medical history and perform a physical exam to rule out any medical disorder that may be causing the release of urine, which is called incontinence. Physical conditions that could result in incontinence include diabetes, an infection, or a functional or structural defect causing a blockage in the urinary tract.

Enuresis also may be associated with certain medicines that can cause confusion or changes in behavior as a side effect. If no physical cause is found, the doctor will base his or her diagnosis of enuresis on the child's symptoms and current behaviors.

How Is Enuresis Treated?

Treatment may not be needed for mild cases of enuresis, because most children with this condition outgrow it (usually by the time they become teens). Knowing when to begin treatment is difficult because it is impossible to predict the course of symptoms and when the child will simply outgrow the condition. Some factors to consider when deciding to begin treatment are whether the child's self esteem is affected by the wetting and whether enuresis is causing impairment in functioning, such as causing the child to avoid attending sleepovers with friends.