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Urinary Incontinence (Enuresis)

What is urinary incontinence (enuresis)?

Urinary incontinence (enuresis) is a medical name for bedwetting, or the accidental urination in children who should be developmentally able to have control of their bladders. Girls usually have bladder control before boys do. The diagnosis of enuresis is for girls over the age of 5 and for boys over the age of 6 that are still having urinary control problems. There are different types of bedwetting that may occur, including the following:

  • diurnal enuresis - wetting during the day.
  • nocturnal enuresis - wetting during the night.
  • primary enuresis - occurs when the child has never fully mastered toilet-training.
  • secondary enuresis - occurs when the child did have a period of dryness, but then returned to having periods of incontinence.

Facts about urinary incontinence (enuresis):

  • Nocturnal enuresis affects 5 million to 7 million children in the US.
  • Nocturnal enuresis occurs almost three times more frequently in boys than in girls.
  • Of the children with bedwetting, most have wetting at night.
  • Primary enuresis is the most common form of urinary incontinence among children.

What causes urinary incontinence?

There are many factors that may be involved, and many theories that are given for why children wet. The following is a list of some of the possible reasons for the problem:

  • poor toilet-training
  • delay of the ability to hold urine (this may be a factor up to about the age of 5)
  • small bladders
  • poor sleep habits or the presence of a sleep disorder
  • a problem with the proper functioning of hormones that help to regulate urination

How is urinary incontinence (enuresis) diagnosed?

Urinary incontinence (enuresis) is usually diagnosed based on a complete medical history and physical examination of your child. In addition to talking with you and the child, your child's physician may perform the following to help rule out other causes for the wetting:

  • urine tests (to make sure there is not an underlying infection, or condition such as diabetes)
  • blood pressure measurement 

Treatment for urinary incontinence (enuresis):

Specific treatment for enuresis will be determined by your child's physician based on:

  • your child's age, overall health, and medical history
  • extent of the condition
  • your child's tolerance for specific medications, procedures, or therapies
  • expectations for the course of the condition
  • your opinion or preference

Prior to starting treatment, it is important to know that:

  • Enuresis at night without daytime symptoms occurs in up to 20 percent of children at the age of five. 
  • The child is not at fault and should not be punished. The child cannot control the wetting.
  • Enuresis usually goes away on its own in about 15 percent of affected children each year. 

Treatment may include:

  • positive reinforcement of the child (i.e., the use of sticker charts for dry nights)
  • use of night-time alarms to help tell the child when wetting is occurring
  • medications, as prescribed by your child's physician (to help control the wetting)
  • bladder training to help increase the bladder size and the child's ability to know when they have to urinate (this is done by having the child wait as long as possible during the day to urinate and let the bladder get full)

In addition, counseling of the child and family may help to determine any stress the child may be under. Strategies for reducing your child's stress will be discussed.

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