Methylphenidate for giggle incontinence.

PURPOSE: Giggle incontinence or enuresis risoria is a socially embarrassing problem characterized by involuntary and complete bladder emptying in response to laughter. To our knowledge the cause of giggle incontinence is unknown, although a functional relationship to cataplexy was suggested. We retrospectively examined the effectiveness of methylphenidate for giggle incontinence in children. MATERIALS AND METHODS: We retrospectively reviewed the charts of patients referred to a pediatric specialty voiding center between 2004 and 2008 for wetting associated with laughter. Patients who met giggle incontinence criteria with no associated urgency or urge incontinence were offered a trial of methylphenidate. Wetting frequency was assessed before and during methylphenidate treatment. RESULTS: A total of 20 patients with a mean age of 12.4 years (range 7.5 to 15.5) met giggle incontinence criteria with no other wetting reported. Incontinence frequency was daily to less than once weekly. After a timed voiding trial 15 of 20 patients (75%) elected a methylphenidate trial, of whom 12 (80%) reported prompt and complete cessation of wetting. Treatment duration was 2 months to greater than 3 years. CONCLUSIONS: Giggle incontinence with no other urinary symptoms is a rare form of incontinence. Methylphenidate was a viable option for giggle incontinence but it was not accepted by all families.

Helping children with nocturnal enuresis: the wait-and-see approach may not be in anyone's best interest.

Nocturnal enuresis-defined as the involuntary passage of urine at night-is a common childhood condition. Although most will outgrow it, a wait-and-see approach is not appropriate if bedwetting is affecting the child's self-esteem or causing stress within the family. This article offers an overview of the causes and effects of the condition; discusses treatment options, including alarm therapy and medication; and describes ways that nurses can provide education and support.