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Enuresis Causes, Symptoms and Treatment

Medical description

Synonym of “bedwetting,” enuresis is the medical term for urinating unconsciously and involuntarily during sleep – whether it is night or day during a nap. In the vast majority of cases, this form of incontinence only affects young children, but it can persist until adolescence for some.

Types of enuresis

Primary and isolated enuresis. Enuresis is called primary when the child has never managed to completely control his bladder. More common in boys , this form of enuresis occurs in 10% to 15% of five-year-olds and in 6% to 8% of eight-year-olds. Its frequency drops around 1% to 2% among 15-year-olds.

Primary enuresis and associated with other symptoms.

Secondary enuresis. It is an enuresis that appears after a period of cleanliness of at least six months according to most sources, but may be up to a year according to some experts.

Possible causes of Enuresis

Several causes may explain enuresis. Depending on the case, they are isolated or associated. The psychological factor occurs especially in the case of secondary enuresies.

  1. Primary and isolated
  • Heredity. When one of the parents has had enuresis himself , the child is enuretic in 44% of cases. The risk climbs to 77% when both parents had the same problem. Recently, Danish researchers have established that a form of enuresis is linked to genetic modification on chromosome .
  • Hormonal disorder. Some cases of enuresis result from delayed maturation of the day-night cycle of secretion of the antidiuretic hormone , which manages the production of urine. Normally, the body must increase the secretion of this hormone during the night to slow the production of urine and thus the filling of the bladder. Otherwise, the bladder eventually overflows.
  • Difficult to wake up. The sleep factor can also play a role. As such, enuretic children do not have a deeper sleep than others, but they wake up more slowly when they feel that their bladder is full and that they must be emptied. Sometimes they even dream that they go to the bathroom.
  1. Primary and Associates: Essentially
  • Bladder immaturity. Primary enuresis results from what is called “bladeless immaturity”, ie a physiological delay of neuromuscular reflexes controlling the bladder.
  • Congenital uropathy.
  1. Secondary or first-secondary
  • Emotional disorder. It can be an emotional disorder or a “refusal to grow up”. Any significant changes or stress can trigger enuresis in a child’s own: birth of another child, family or school difficulties, divorce of parents, school change, sexual violence, serious bullying by other children, etc. Affective disorders mainly explain secondary enuresies. In addition, they may also appear with the persistence of primary enuresis, which sometimes aggravates the disease.
  • Organic disorder or disease. Enuresis can be a symptom of organic disorder or illness, among which:

– Diabetes mellitus or tasteless;
– malformation of the urinary tract of congenital origin;
– urinary tract infection.


Symptoms for non-isolated enuresies

  • Those related to bladder immaturity: diurinal urinary signs associated with enuresis: very urgent urges with great difficulty in restraining themselves, increased frequency of urination, diurnal leakage;
  • Those related to a urinary infection: feeling of discomfort or burning when urinating, possibly fever, abnormal frequency of urination during the day, cloudy or very odorous urine, etc.
  • Those related to diabetes: excessive elimination of urine, increased thirst, weight loss, fatigue, weakness.
  • Those related to uropathy, especially in boys: difficulty trigger, pushing urination, etc.


People at risk for Enuresis

  •  Children with one or both parents who have already had enuresis.

Risk factors

  • Emotional stress: birth of another child, family or school difficulties, divorce of parents, change of school, etc.
  • Constipation (often associated with enuresis).
  • Encopresis  : quite rare in the population, it often accompanies enuresis.
  • Parents too restrictive or too passive in relation to toilet training.
  • Big family.
  • Behavior and language disorders, psychomotor disorders
  • Sleeping troubles.

Treatments of Enuresis

1) Initial measures in all cases

  • Check the child’s urinary hygiene : organization of urination (6 urination per day on average), quality of urination (for girls, sitting well feet, and take the time to empty), adequate water intake   in the day to obtain a good water restriction in the evening, drink quality (reduce the consumption of caffeine products: cola-type soft drinks, hot chocolate and chocolate bars.)- Remind the child not to drink in both at three o’clock before bed;
    – Recommend that you empty your bladder well before going to bed (and to do this, twice instead of one).
  • Make sure your child has regular bowel movements , adjust diet and treat constipation if needed.
  • Preserve self-esteem, involve the child in treatment and play down: 
    – Do not punish, make feel guilty or ridicule the child. Creating anxiety in the child can only aggravate the problem. We must rather explain to him in simple terms what is happening so that he can follow the recommendations that will be made to him; possibly use a support such as a book (adapted to the age) which can give the explanations.
    – Do not force the child to wear diapers because of their infantilizing connotation . In a pinch, we can make him wear super-absorbent underwear
  • Improve the waking ability by first establishing an autonomous morning alarm clock with an alarm. As soon as the child is awake, he must go to urinate. In this way, removing the layers will facilitate autonomous awakening at night.- Adapt the sleeping arrangements (do not sleep high, if the toilets are far to put a pot in the room, avoid late bedtime that will make it difficult to wake up at night if necessary);
    – Install a commode or small pot and leave a lit night light near the child’s bed to encourage him / her to get up when needed (which will be particularly indicated if the child is afraid of black and afraid to go alone to the toilet);
    – explain and remind him of the importance of getting up during the night as soon as he feels the urge to urinate;
    – Involve the child in the washing of sheets or wet clothes as soon as he gets up. He should also replace his own bedding.
  • Facilitate the life of the child and parents by protecting the mattress with a cover made of vinyl.

These measures eliminate  isolated primary enuresis in approximately 30% of cases. Be sure to apply them before considering drug therapy and / or vesico – sphincteric retraining . At the same time, it may be prudent to perform checkups at your family doctor such as urinalysis, boy’s urinalysis, and possibly kidney and bladder ultrasound .

With regard to secondary enuresis, consulting your doctor is essential to check that there is no organic cause, before consulting a psychologist or a child psychiatrist to possibly search for and take care of the psychological factors likely to trigger it.

2) Behavioral therapies: essentially for isolated primary enuresis

Alarm device adapted. This type of alarm reacts to a few drops of urine and thus helps to wake the child as soon as he begins to wet his bed. It works by means of batteries and is inserted in a special layer, or special alèze which is carried on the body. According to the Committee of Community Paediatrics Canadian Pediatric Society, this approach should represent the first-line treatment in case of primary enuresis and isolated. Opting for this device requires motivation from the child and parents. At least the time the child gets used to and wakes up by him to the sound of the alarm.
Easy to use, the alarm devices have a success rate of 70% in the long term and are used for three or four months. It can take from one to two months before the bladder control improves. This treatment works best with children at least seven or eight years old.

Motivation therapy. This is a reward-based therapy best suited for children over six years old. On a calendar, the child notes his progress by indicating which nights were “dry” or “wet”. For every night he does not wet his bed, he can stick or draw a symbol (golden star, sun / rain). When he has completed a painting, he can choose a small reward according to his progress.

3)  Medication

The following products are generally used when non-drug techniques do not work.

Desmopressin. This rather expensive drug is an analogue of the antidiuretic hormone used to fight enuresis cases related to insufficient secretion of this hormone. According to recent studies, 50% of children remain “dry” more than a year after stopping use.

Oxybutynin. In the case of bladder immaturity, it is prescribed for a duration that will depend on the diurnal symptoms and complications. This treatment is a muscle relaxant of the bladder which will allow a calm bladder filling and will increase the bladder capacity.

Medications to treat the underlying causes:
– If the child has a urinary tract infection, he or she will be prescribed a suitable antibiotic;
– If the child is constipated despite the appropriate dietary measures, he must follow a laxative treatment.
4) Psychotherapy

When the problem is clearly related to an affective disorder, the doctor will recommend psychotherapy.

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