By Gilda Morales, ANP, DC
Today’s column deals with bedwetting, or enuresis, which is medically defined as involuntary urination after the age when bladder control is expected, usually in children greater than the age of 6. More commonly, the term refers to bedwetting primarily at night. The condition affects more females than males, and there is usually a family history of enuresis.
There is no confirmed cause for enuresis, but there are several theories that have been proposed, including abnormal anatomy, increased pressure on the bladder with laughing, coughing or sneezing, urinary tract infections, and even emotional stress or sexual abuse. Social changes such as divorce, new siblings, a change to a new school, or death of a loved one can also trigger enuresis.
Besides the obvious discomfort from being wet, there are emotional effects as well as embarrassment and teasing from playmates or classmates.
The physical exam is geared toward ruling out physical causes of enuresis and will include a neurological exam to rule out brain tumors, abdominal exam to rule out kidney tumors, examination of the genitalia, to rule out numerous abnormalities, and the spine to check for underlying spinal defects.
Treatment can consist of positive interventions, never negative, such as punishing the child for wetting the bed. Formal programs that have been developed by pediatric psychologists are quite successful and consist of the use of an enuresis alarm and positive reinforcement and rewards. Hypnotism has also shown a significant success rate especially if used in conjunction with the bed alarm.
There are medications that have shown some success, but they are not recommended for use in children before the age of 6 to 8 years of age because of the potential for serious side effects. Fortunately, 99% of cases resolve without treatment by the age of 5.
