Enuresisby Dr. Deane G. Baldwin

Enuresis is a term used for a child that soils his/her clothing or bed linens with urine after most other children, the same developmental age, have ceased to do so.

The Diagnostic and Statistical Manual for Mental Disorders (DSM-IV) regards five years of age, or the developmental equivalent, as the age where urinary soiling should terminate. Enuresis is so common in children that one is obliged to believe it to be a developmental phenomenon that should be given a wide latitude of tolerance before it is considered abnormal. There are many normal variables that are involved in urinary tract structures and function that dictate urinary continence. Furthermore, many abnormal urinary tract conditions including infection, obstruction, and abnormal neural mechanisms and depth of sleep are common in childhood.

Nocturnal Enuresis (bed-wetting) is far more common than daytime enuresis. More than likely nerve related control mechanisms and their link to sleep play an important role in causing bed-wetting. If medical disorders can be ruled out as a cause for bed-wetting, one should be patient until maturation is complete.

However, when children sleep with others or spend the night out with friends and wet the bed they become victimized by their problem regardless of the cause. Parents often become confrontational because of the frustration they encounter with the nocturnal activity of changing nightclothes and bed linens. When these things happen the enuretic child can and often does have difficulty coping and will develop alterations in mood or conduct.

Physicians now have a variety of successful medical treatments for bed-wetting. If bed-wetting is impacting the sense of well being for a child then valid medical treatment is in order. Deliberate bedwetting is usually associated with a psychosocial disorder and should be evaluated and treated similarly to daytime enuresis.

Daytime enuresis or soiling with urine can be quite a different problem. Medical attention should be initiated early where disorders of the urinary tract can be discovered and treated. When there is no organic cause found, the problem usually enters the realm of mental or psychosocial disorders.

Daytime enuresis should be evaluated for stress factors that can precipitate the problem. Divorce, abuse and sibling rivalry are but a few examples of stressful situations causing the problem. Intervention should also address adversarial reactions of adults and ridicule by peers and adults. The daytime enuretic child should also be evaluated for developmental and psychosocial disorders as well. For example, depression, anxiety, learning disorders, conduct disorders and many other mental disorders should be checked out.

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