ENURESIS IN CHILDREN (BEDWETTING)

ENURESIS OVERVIEW

Enuresis also known as bedwetting as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) is the involuntary continuous lack of control of the bladder that occurs two to three times in a week in children within age of 5 years or beyond up to 15 years in absence of any organic or pathological cause. Enuresis is not considered a mental disorder but classified as a symptom of enuretic syndrome; it could also be an indicator of an underlying medical condition. Sometimes it occurs during the day, but mostly occurs in the night, it is also affects both gender and it is common in children with Attention Deficit Hyperactive Disorder (ADHD).

TYPES OF ENURESIS

The type of enuresis is classified according to time of occurrence, which are

  1. Nocturnal Enuresis; It is also known as monosymptomatic enuresis, in which bedwetting only occurs at night time during sleep in children. It is the commonest form of enuresis in which the bladder function is normal with no complains of pain during urination or issues with the urinary tract.
  2. Diurnal Enuresis: Bedwetting occurs during the day in children due to some pathological causes like inability to inhibit sleep during the day, the problem can be as a result of some disorders like spina bifida, stroke or tumor sometimes it could be the child is suffering from anxiety or depression.
  3. Non-monosymptomatic Enuresis; This type is the combination of the nocturnal and diurnal enuresis, wetting during the day and in the night which can be due to urinary bladder problems like bladder storage or emptying problem, pain during urination, urge symptoms or postponement of urination etc. it can also be due to gastrointestinal problems like constipation.

CAUSES OF ENURESIS

Medically there is no exact cause of enuresis, since it’s a functional disorder there are some possible causes which are listed below

  1. Emotional stress/anxiety related to behavioral disorders or psychological issues
  2. Its sometimes Hereditary
  3. Structural problems of the bladder and urethra
  4. Faulty toilet training
  5. Hormonal problems
  6. Diabetes
  7. Infection
  8. Chronic constipation

DIAGNOSIS OF ENURESIS

Accurate diagnosis of enuresis depends on how careful the case history of the child id taken, therefore a thorough assessment and examination is needed to be done to get an accurate diagnosis. Some diagnostic tools used are

  1. History taking (especially family history)
  2. Psychiatric and physical assessment with use of questionnaire or checklist
  3. Urinary test; it is done to detect any infection that can cause enuresis
  4. Cystoscopy ; it is the insertion of tube into the bladder to check for any tumor
  5. Urodynamic testing; it is the test of the lower urinary system to detect any abnormality  

TREATMENT OF ENURESIS

The treatment of enuresis depends on the causes and factors associated with it, parent cooperation is needed in treatment also. There are therapies used in treatment which are listed below

  • NON-MEDICAL THERAPY; it includes the behavioral and counseling therapy. This is very important because counseling the parents on things that is needed to be done properly and actions that is needed to be taken in treatment of bed wetting. Some of the counseling therapies done are
  • Education on proper food and fluid intake
  • Stop fluid restriction and punishing the child for bedwetting
  • Tell the child to always pee before going to bed to sleep either during the day or at night
  • Not reducing the self-esteem of the child through saying harsh and insultive words instead try and talk to them calmly on what is needed to be done, if positive response is gotten praise them accordingly so they improve on themselves better.
  • Appropriate information regarding proper toilet training
  • ALARM THERAPY; it is the most effective treatment for enuresis, it makes use of a metal sensor placed on the child’s body which consist of a sound system that consist that is linked to humidity detector that provides a warning sign once the urine has been detected by the detector, then starts to ring which allows the child to wake up and pee in the toilet. It is advised and recommended to be used for 10 to 16 weeks, it allows the children know how to control their bladder and wake up when the bladder is full. It is very effective. There are mainly two types which are
  • Body worn alarm placed in the underpants or diaper
  • Bed side alarm placed on the bedside or under the bed sheets

Alarm therapy used

  • Medical therapy; this therapy is used when the non-medical and alarm therapy doesn’t work in treatment of enuresis. The medications prescribed are desmopressin and Tricyclic antidepressants. Desmopressin with fewer side effects is mostly preferred. It is less effective for treatment of enuresis.

COMPLICATION OF ENURESIS

It does not really pose a physical complication but if it is not under control it affects the child mental health cause isolation, low self-esteem and feeling of guilt in front of family and friends.

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