Enuresis

Key Features

• Defined as repeated urination into the clothing during the day and into the bed at night by a child who is chronologically and developmentally older than 5 years

• Must occur at least twice a week for 3 months

• Has been categorized by the International Children's Continence Society as monosymptomatic or non-monosymptomatic

  • Monosymptomatic enuresis is uncomplicated nocturnal enuresis (NE; must never have been dry at night for over 6 months with no daytime accidents); it is a reflection of a maturational disorder and there is no underlying organic problem

  • Complicated or non-monosymptomatic enuresis often involves NE and daytime incontinence and often reflects an underlying disorder

Clinical Findings

• Child does not achieve urine continence by 5–6 years of age and generally has no underlying pathology to which the incontinence can be attributed

• Child does not respond to a full bladder or rectum

• More common in boys than in girls

Diagnosis

• Involves a complete history and physical examination to rule out any anatomic abnormalities or underlying pathology

• Urinalysis should be obtained, including a specific gravity

• Urine culture should be obtained, especially in girls

Treatment

• Involves education and the avoidance of being judgmental and shaming the child

• A variety of behavioral strategies have been used such as limiting liquids before sleep and waking the child at night so that he or she can go to the toilet

• If this simple approach is unsuccessful, the use of bedwetting alarms is suggested

  • A form of cognitive-behavioral therapy

  • Has been found to cure two-thirds of affected children

• Desmopressin acetate (DDAVP), an antidiuretic hormone analog

  • Has been used successfully when nonpharmacologic strategies fail

  • Decreases urine production

• Imipramine, a tricyclic antidepressant, also has been used successfully but should be used only as last resort due to risk of death from overdose

• When such medications are stopped, there is a very high relapse rate