Diseases & Conditions

Bladder Incontinence - Enuresis


Overview, Causes, & Risk Factors

Enuresis is the intentional or involuntary voiding of urine into clothes or other inappropriate places by a child who is at least 5 years old. To meet the criteria for enuresis, the involuntary or intentional voiding must occur at least twice a week or more for three months.

What is going on in the body?

In a child with enuresis, there is no physical disorder. Primary enuresis occurs when bladder control has never been achieved. Secondary enuresis occurs when bladder control has been achieved for at least one year but has then been lost. Enuresis may occur only at night, only in the day, or during both day and night.

What are the causes and risks of the condition?

Causes of enuresis are usually psychosocial and physiologic. Children with enuresis often have other developmental delays. They tend to have smaller bladders and a higher likelihood of a learning disability. A link between enuresis and a sleep disorder may be involved, but there is no clear proof of this.

Genetics may also play a role in the development of enuresis. Having one enuretic parent increases the chance of the child having enuresis by 45%. If both parents are enuretic, the risk increases to 75%. About twice as many males as females are enuretic.

Some cases of enuresis are related to toilet training that was begun too early or was very forcible. Enuresis may be a temporary regression or an adjustment problem. Parents who are very controlling and quick to find fault may also trigger problems with bladder control.

Medical causes of enuresis include the following:

  • bladder stones
  • constipation
  • diabetes insipidus
  • diabetes mellitus
  • epilepsy
  • lower urinary tract obstruction
  • neurogenic bladder, which is a bladder with impaired nerve function
  • sleep apnea, which is a breathing disorder that occurs during sleep
  • stress
  • urinary tract infection

  • Symptoms & Signs

    What are the signs and symptoms of the condition?

    A child with enuresis urinates into clothing or other inappropriate places. The urination may be accidental or intentional. Nighttime enuresis is the most common.


    Diagnosis & Tests

    How is the condition diagnosed?

    A healthcare provider will conduct a thorough physical exam. He or she will check for any physical causes. A complete medical, developmental, and psychosocial history should be done. This will help determine what factors may be contributing to the problem. The provider may order a urinalysis, which is a urine test to check for infection or other abnormalities. More complex tests of the urinary tract may be done if any disorders are suspected.


    Prevention & Expectations

    What can be done to prevent the condition?

    There is no way to prevent enuresis caused by problems with development or anatomy. Parenting problems can be addressed with family therapy. It's important to start toilet training only when the child is ready. When toilet training does begin, there should not be pressure on or criticism of the child. Helping children prepare for stressful events can help prevent enuretic episodes in response to stress.

    What are the long-term effects of the condition?

    If the enuresis is not treated, it may cause emotional and developmental problems for the child.

    What are the risks to others?

    Enuresis is not contagious and poses no risk to others.


    Treatment & Monitoring

    What are the treatments for the condition?

    Treatment of enuresis falls into three categories. These are behavioral, medication, and counseling. Usually more than one treatment is used at a time.

    Behavioral treatment includes:

  • behavioral rewards for achieving bladder control
  • bladder training, such as bladder stretching exercises to gradually increase the size of the bladder
  • conditioning methods, such as using a bedwetting alarm that awakens the child if the bed gets wet
  • decreasing evening fluids
  • teaching the child to attend and respond to bladder sensations at night
  • Medication is not the first treatment choice. It is often not used at all. Medication is used only when the problem interferes with the child's ability to function or only for special occasions.

    Counseling alone is rarely effective. A behavioral treatment regime needs to be established. Managing family stress and tension is important.

    What are the side effects of the treatments?

    Medications used to treat enuresis may cause allergic reactions. One drawback to medications is that the bedwetting typically returns when the medication is stopped.

    What happens after treatment for the condition?

    Once the child has regained control over his urination, the problem is generally resolved. However, factors such as stress or another urinary tract infection may cause another episode of enuresis.

    How is the condition monitored?

    Any new or worsening symptoms should be reported to the healthcare provider.


    Attribution

    Author:Terry Mason, MPH
    Date Written:
    Editor:Ballenberg, Sally, BS
    Edit Date:03/28/01
    Reviewer:Eileen McLaughlin, RN, BSN
    Date Reviewed:08/06/01