It has been estimated that in the United Kingdom alone over half a million children between the ages of 6 and 16 years regularly wet the bed and more of these are boys than girls. Children vary in the age at which they are physically ready to have complete control over their bladders. Many children are not ready for toilet training before the age of 3. Enuresis usually does not indicate an emotional or physical problem but can do. Disorders main features are:

Diagnostic criteria for 307.6 Enuresis
( cautionary statement )

It has been estimated that in the United Kingdom alone over half a million children between the ages of 6 and 16 years regularly wet the bed and more of these are boys than girls. Children vary in the age at which they are physically ready to have complete control over their bladders. Many children are not ready for toilet training before the age of 3. Enuresis usually does not indicate an emotional or physical problem but can do. Disorders main features are:

• Accidentally or on purpose, the patient repeatedly urinates into clothing or the bed.
• The clinical importance of this behavior is shown by either:

It occurs at least twice a week for at least 3 consecutive months or
I t causes clinically important distress or impairs work (scholastic), social or personal functioning

• The patient is at least 5 years old (or the developmental equivalent).
• This behavior is not directly caused by a general medical condition (such as diabetes, seizures, spina bifida) or by the use of a substance (such as a diuretic).

Specify type:

Nocturnal Only
Diurnal Only
Nocturnal and Diurnal

Associated Features:

Although the great majority of children with Functional Enuresis do not have a coexisting mental disorders, the prevalence of coexisting mental disorders is greater in those with Functional Enuresis than in the general population. Functional Encopresis, Sleepwalking Disorder, and Sleep Terror Disorder may also be present. Other associated features may include:

Limited Social Interaction.
Lower Self-Esteem.
Rejection by Peers.
Anger/Punishment by Parents.
Behavior Problems/Conduct Problems.
Underachievement in School.

Differential Diagnosis:

Some disorders have similar or even the same symptoms. The clinician, therefore, in his/her diagnostic attempt, has to differentiate against the following disorders which need to be ruled out to establish a precise diagnosis.

 Current medical problems particularly urinary or bladder infections.

Cause:

Enuresis may have a number of causes which can include the effects of internal marital disputes, fear, lack of self confidence and medical problems.

Treatment:

The treatment of enuresis can take a multiple approach; parental understanding, possible through counseling for the parent and psychotherapy for the child, to mechanical and behavioral devices employed to assist in braking the bedwetting cycle.

Counseling and Psychotherapy:

Talking to your child calmly about the problem can sometimes uncover fears or anxieties. Behavior modification techniques such as rewards for remaining dry at night (the rewards increase in value as the number of consecutive dry nights increase

Behavioral& Other:

Night-time Protection Pants
Ensure easy access to the toilet at night
Encourage a good level of fluid intake throughout the day
Encourage small steps, such as going to the toilet before bed without prompting
Enuresis alarm or buzzer

Pharmacotherapy:

In older children, imipramine may be prescribed, but close observation of the child's response to medication must be maintained. Imipramine may begin to work by the first or second night. Treatment usually lasts 4 to 6 months.