Enuresis

Objectives

After completing this article, readers should be able to:

1. Describe the causes of daytime wetting.

2. Discuss the pathophysiology and causes of nocturnal enuresis.

3. Understand the behavioral treatment of incontinence.

4. Characterize the medical treatment of daytime incontinence.

5. Know the treatments for nocturnal enuresis.

Introduction

Both day and night wetting can pose a significant problem for children, parents, and medical practitioners. The prevalence of day wetting in 7-year-old children is between 2% and 3% for boys and 3% and 4% for girls. Most cases represent a functional type of incontinence, with only a few cases due to an anatomic, neurologic, or psychiatric cause. Most children typically are trained prior to starting school, but those who continued wetting rated this happening as a significant embarrassment and life stressor. Wetting often is a significant complaint raised during a visit with the pediatrician. Data suggest that children who have prolonged enuresis have lower self-esteem.

Primary nocturnal enuresis (PNE) is defined as nocturnal wetting in a child who has never been dry on consecutive nights for longer than 6 months. It is estimated that between 5 and 7 million children and adolescents may suffer from this disorder. The incidence of PNE is based on age. Dryness is expected to be achieved by 5 years of age; if not, the child is diagnosed as having PNE. An estimated 10% to 15% of 7-year-old children still struggle with bedwetting. Nocturnal enuresis resolves at a rate of 15% per year, so 99% of children are dry by age 15 years. The social consequences of nocturnal enuresis lead many to seek medical attention.

To clarify day and night wetting, the International Children's Continence Society recently published new standardization for the terminology of enuresis. (1) They define incontinence as uncontrollable leakage of urine that may be intermittent or continuous and occurs after …