What is enuresis?

Enuresis or simply termed 'bed wetting' is defined as voluntary or involuntary release of urine into bedding, clothing or other inappropriate places. The condition is mainly focused on children although the condition prevails with the adults as well. But in adults, it is more commonly explained as 'incontinence' than Enuresis.

In children the condition is not taken as a problem until the child develops full bladder control by the age of 5 years or even up to 7 years. If the condition persists thereafter, specialist advice needs to be obtained.

The most common of the enuresis would be the Nocturnal Enuresis even though the day time enuresis and diurnal enuresis is also present. There are two types of enuresis noted among children. Primary enuresis which is explained as not being able to attain bladder control since birth or secondary enuresis, which means that bladder control has been achieved for 6 or more months and enuresis occurs subsequent to achieving the bladder control.

Enuresis among children as a secondary occurrence could well be linked with stressful life events, such as a birth of a sibling, bereavement, divorce of parents or even moving to a new house. Primary enuresis seems not to be associated with psychological disorders but rather due to immature nerves failing to signal the full bladder at the right time.

In adults, the common scenario would be an elderly patient with Alzheimer's disease who has lost the bladder control. It also more frequently associated with uncontrolled diabetes mellitus, urinary infections, medication and weakened bladder musculature.

Enuresis can be treated in several ways.

Behavioural modifications: The child can be conditioned based on a repeated practice thus making him to involuntarily follow the practice even without the condition. Some of the techniques would be; to use an alarm and a pad where the alarm rings each time the pad becomes wet. At the time, the child is taught to get up and use the toilet to empty the bladder. Waking the child after few hours of sleep in the night and asking them to use the toilet is another method. It is shown that after few weeks the children would themselves wake up and empty the bladder rather than waiting for the bell to ring. Some other ways of managing enuresis would be to restrict fluid intake before going to bed and positive re-enforcements for dry days, showing understanding and being sympathetic about wet episodes. Ensure that he knows it is not his fault.

Medications: Imipramine which is a antidepressant and Desmopressin acetate (DDAVP) have been used with success in treating enuresis. But it is not the first line of treatment in bed wetting.

Psychotherapy: Secondary enuresis would ideally be treated with psychotherapy as it can possibly due to the stressful incident in the child's life.

Although many options are available the parents have to be reassured in every instance. The child needs to be shown support and sympathy and the parents need to know that the child will grow out of the problem with time.