Enuresis

Enuresis is a pattern of discharge of urine by a child age 5 or older. It can be distressing and a source of embarrassment for a child but is not physically harmful.

An estimated 5 to 10 percent of 5-year-olds experience enuresis, along with 3 to 5 percent of 10-year-olds and 1 percent of 15-year-olds, according to the DSM-5. In roughly 1 percent of children with the condition, it continues into adulthood; for most, it ends by adolescence.

Symptoms

For a diagnosis of enuresis, according to the DSM-5:

  • A child urinates—involuntarily or intentionally—in bed or into clothes
  • This occurs at least twice a week for three months in a row or causes significant distress or impairment in functioning
  • The child is at least 5 years old (or at an equivalent level of development)
  • This behavior must not be attributable to a substance's physiological effects or another medical condition

Nocturnal enuresis is the most common form and is defined as incontinence only during nighttime sleep. Diurnal enuresis, the voiding of urine only during waking hours, may occur when a child experiences sudden urges to urinate or because they consciously postpone urination. A combination of nocturnal and diurnal enuresis can occur.

The level of impairment that results from enuresis can vary based on such factors as its effect on a child's self-esteem and social activity and the degree of negative response from caregivers.

Enuresis may affect children who have never established urinary continence as well as those who established continence prior to experiencing wetting incidents. 

Causes

Enuresis is associated with delayed development of the circadian rhythms of urine production. Children whose parents experienced enuresis are more likely to have nocturnal enuresis, and research shows that the risk of having the condition is influenced by genetics.

Inadequate toilet training and stress have also been posited as factors that predispose a child to enuresis, according to the DSM-5.

Treatment

Neither punishing a child for wetting nor ignoring it is helpful, according to guidance from the U.S. National Library of Medicine's MedlinePlus. Instead, parents should take a patient approach to helping children establish urinary continence. This can include encouraging a child to go to the bathroom at regular times—including before bed—and to not hold urine for an extended period. Parents may also reward a child for nights without bedwetting, and praise efforts to try. A bedwetting alarm can also be purchased to alert a child who begins to urinate to use the restroom.

A child's health care provider can identify causes of wetting, determining whether it is related to any other condition, and can recommend treatment. As one part of treatment, doctors sometimes prescribe a medication such as desmopressin, which reduces the amount of urine produced at night.

References

  • Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
  • U.S. National Library of Medicine

Last reviewed 02/07/2019