Enuresis is involuntary urination, also termed incontinence, which can occur during the day or night. Nighttime incontinence is called nocturnal enuresis. Enuresis is a normal physiologic response between 2 to 4 years of age. Beyond this age, enuresis may be a functional disorder, related to physical development, a structural or disease process, or an emotional or behavioral disorder. The National Association for Continence reports that over five million American children and 25 million adults experience enuresis.
Primary Factor
The National Institute for Diabetes and Digestive and Kidney Diseases (NIDDK) reports that the functional level of development of a child is a primary factor in nocturnal enuresis. In some children 5 to 10 years of age, the central nervous system is not fully developed and the child does not have the ability to wake up from sleep when the bladder is full or to prevent the bladder from emptying during sleep.
Another functional cause is that of bladder capacity. The growth of the bladder may not match the growth of the child. A compounding factor can be insufficient production of the anti-diuretic hormone (ADH) during sleep. At night, production of ADH should increase so that less urine is produced by the kidneys. For some children, this does not occur and the kidneys continue to produce daytime amounts of urine, leading to nocturnal enuresis.
Genetics may be the cause for the delays in functional development and hormone production. According to the NIDDK, if a child's parents both had nocturnal enuresis, he has an 80 percent chance of also being a bedwetter.
Psychogenic Causes
Psychogenic causes are emotional and behavioral in nature. Stressful events during bladder training or following complete bladder training can cause enuresis. For example, fighting in the family, big changes to daily life like moving or overwhelming family events like the birth of a sibling, divorce or military deployment of a parent can create anxiety in a child, leading to regression in behavior like enuresis.
Behavior and Lifestyle Modification
Behavior therapy and lifestyle modification create conditions favorable to continence. Establish routines like having your child go to the bathroom before sleeping and limiting fluids in the evening. Eliminate sodas, caffeine and other bladder irritants from your child's diet. Reward your child for dry nights and have him help you change the linens when he wets the bed.
Pharmocologic Therapy
The National Institutes of Health reports that Desmopressin has been used on a short-term basis (four to eight weeks only) to treat pediatric nocturnal enuresis. Desmopressin is a synthetic form of the natural human anti-diuretic hormone. Side effects are dose related; most common are headache, slight rise in blood pressure and nasal congestion if taken intranasally.
Considerations
Enuresis may be caused by structural disorders and disease processes. Common pediatric structural problems include a small bladder or an improperly functioning urethral sphincter in boys and ureter sphincter in girls. Because there are many disease processes that can cause enuresis, you should have your child evaluated by a doctor to rule out any serious health problems such as spinal cord dysfunction, diabetes or kidney disease.
