Treatment for Enuresis

ABSTRACT

Monosymptomatic enuresis(bed-wetting without other symptoms) is a common problem in children, affecting 15% of five-year-olds and occurring more frequently in boys than in girls. Because it is usually caused by a physiologic maturational delay, the prevalence decreases with age. Children with enuresis have a small bladder capacity. Failure to awake to the micturition urge is not necessarily related to being a "deep sleeper", and children with enuresis may pass urine involuntarily because of the immature central nervous pathways. As the CNS pathways matures with age, most children are more easily aroused from sleep. There is strong evidence of a genetic predisposition for enuresis. Children with enuresis must be evaluated to reveal any underlying physiologic conditions or disease states, such as urinary tract infection or structural abnormality. Once these are ruled out, the goal is to stop the bed-wetting while preserving the child's self-esteem. However, before treatment of enuresis, concurrent problems, such as daytime enuresis and urgency or chronic constipation, should be managed. For the treatment of enuresis, the child wears a moisture alarm-a small, portable, transistorized device-to bed. The alarm sounds or vibrates when wet, awakening the child. Drug therapy for enuresis includes desmopressin, which decreases the urine volume, and imipramine and oxybutynin, which inhibit bladder contraction. Both delayed urinary control and current enuresis are associated with a markedly increased risk of behavioral, emotional, and academic problems.