Enuresis commonly known as bed wetting is a frequent problem encountered by parents. Bed wetting could be voluntary or involuntary. Bladder control is generally acquired by the age of 5 years. Less than 5% of children have this problem beyond the age of 10 yrs. Males preponderance is present in this problem. A child is branded as enuretic if urine is voided twice a week for at least 3 consecutive months or when clinically significant distress occurs in areas of the child’s life as a result of wetting.
Causative factors include genetic predisposion, physiological pattern and psychological factors. It is commonly associated with attention deficit hyperkinetic disorder. Discordant family, traumatic childhood, child abuse are few of the other causes of bedwetting.
Bed wetting may be primary – where the child has never been dry at night, secondary—in which a child who has been continent for 6 months or longer then begins to wet the bed. Primary enuresis account for about 90% of the cases. Urinary tract infection and diabetes are also common causes of bed wetting. Anatomic abnormalities of the bladder can cause bedwetting.
Common steps useful in treating the child suffering from enuresis are as follows. Treatable causes should been corrected and may be the only treatment required for enuresis. However, primary enuresis requires behavioral therapy for solving the problem. Positive reinforcement has a success rate of about 85% or more. The child should be rewarded if he/she is dry a night. Star chart where a star is put on the calendar on the day when the child is dry. The child should void before retiring. Enuresis alarm is available in the market which trigger every two to three hours and is a useful tool in the treatment of enuresis. Negative reinforcement in the form of punishment and humiliation by parents and siblings should be discouraged.
Certain drugs are useful in the treatment of bedwetting. Imipramine and desmopressin acetate are two drugs approved by FDA in the treatment of enuresis. Dosage should be adjusted in consultation with a doctor. Continuous treatment for a period of 6 months has been found to be very useful in this regard. Relapse is known but drugs with behavioral therapy augment the final outcome of the disease.