Enuresis is an inability to control urine that may occur during the day or night. This is usually not a cause of concern until the child is past the age of five. Almost 100% of children will be dry by the age of 15 years. Most children seem to wet more at night. This may be related to the way the human develops self control of the urinary system and the bowels.
It is felt by some that enuresis may be delay in the development of control and that no other abnormality exists in the child. Sometimes children may start to be wet after they have been dry for some time. This is usually related to periods of stress. It is well known that enuresis runs in families. The children of patients who were bedwetters have a higher incidence of bedwetting. Most urologists feel that tests should be limited on children who present with enuresis.
Extensive testing is usually not warranted, however a good history and physical exam and performance of a urinalysis and culture is necessary to rule out other potential diagnoses. In those patients where there is the concern of a urinary tract abnormality, ultrasound may be obtained.
Usually there is no cause that can be directly treated. Some families might elect not to treat the child as some of the medications may have side effects. Some medications may be utilized to relax the muscles of the bladder and to attempt to increase the volume that the bladder can store. Newer agents decrease the production of urine at night. A motivated child is the key to the success of any treatment modality.
Rewarding success and increasing the child’s responsibility work well. Conditioning is the most effective therapy. The use of alarms appears to work well. Modern alarms are safe and inexpensive.