A Family Doctor's Tale -ENURESIS

DOC MY CHILD HAVE ENURESIS


Bedwetting or functional enuresis is the repeated involuntary voiding of urine during day or night at an age where continence or control of urine is expected.

Bedwetting or functional enuresis is common in children.
Prevalence of bedwetting:
5 years old - 7 per cent for boys and 3 per cent for girls
10 years old -3 per cent for boys and 2 per cent for girls
18 years old -1 per cent for boys and 0 per cent for girls

It usually occurs during non rapid-eye-movement (REM) sleep.

The causes of bedwetting are:



1.family history of bedwetting often present

2.prevalence of emotional and mental disorder greater than in general population such as anxiety or rejection

3.slow physical development,

4.an overproduction of urine at night,

5.a lack of ability to recognize bladder filling when asleep

Symptoms

1.day or night involuntary voiding of urine after the age of 5 years at least twice a month or continuously.

2.In older children more than once a month

3.Sometimes a child develops bedwetting in response to jealousy or reduced attention from parents or caretaker after a new child is born into the family

Complications:
Amount of urinary incontinence is related to effect on the child's emotional or psychological well being:
1.self esteem is affected

2.social ostracism by peers

3.anger at caretakers

4.rejection by caretakers

Diagnosis and treatment

1.an underlying condition such as urinary tract infection, developmental bladder abnormalities or nervous system disorders must be ruled out by tests conducted.

2.A "wait and see" approach is the preferred course of action. Record the days when the child is dry and give a reward as a form of motivation.

3.Regulate the amount of fluid taken before bedtime

4.Patient and family counseling will take out the anxiety and fear of rejection by the child

5.Use of urine sensitive device that detects wetness and activate auditory stimulus can help the child condition the response of waking up before he loses control of his bladder. This method is called behavioral conditioning.

6.Medicine such as antidepressant can help to control bedwetting in children but only as as a short-term measure.

Prognosis:
Fairly good with counseling and motivation