How is it defined? Is it common?

Enuresis is the involuntary elimination of urine during sleep in children aged five years or older. It occurs in 5% to 10% of children under ten years old and is more common in boys.

Causes

Urine is produced by the kidneys and carried through the ureters to the bladder, where it is stored. When the bladder is full, it sends a message to the brain, which makes the urge to urinate conscious. Disorders in any of these steps can lead to enuresis:

decreased ability to wake up during sleep (very deep sleep)
excessive urine production by the kidneys at night
overactive bladder, which contracts and expels urine easily, even with small stored volumes
enuresis is often observed in other family members, indicating a possible hereditary component

Secondary enuresis may be related to stress, the birth of a sibling, parental divorce, school or family difficulties, and is often temporary. Other general or urinary tract diseases may also induce secondary enuresis or worsen primary enuresis.

Symptoms

It was once believed that enuresis always had a psychological origin. Today, it is known that primary enuresis does not result from negative or traumatic experiences. However, anxiety and social difficulties (such as avoiding sleepovers or school camps), low self-esteem, guilt, and withdrawn behavior are common findings. These manifestations are consequences of enuresis and generally resolve with its cure.

Daytime symptoms such as urgency to urinate, urine leakage, increased or decreased urination frequency, or changes in the urinary stream indicate urinary dysfunction associated with enuresis. In such cases, the enuresis is called “non-monosymptomatic” and requires individualized, multidisciplinary treatment.

Treatment

Some general guidelines can help manage enuresis. Parents should reassure the child that not controlling urination is involuntary and not their fault. They should also encourage the child to maintain social activities. Waking the child to go to the bathroom and completely restricting fluids at night are generally ineffective. It is recommended to increase fluid intake during the day (every 2 to 3 hours), which reduces nighttime thirst. Foods with caffeine (including soft drinks) and high salt content should be avoided at dinner. Urinating every 2 to 3 hours should be encouraged, as well as keeping a daily record of dry nights or nights with urine loss, which allows for positive reinforcement and better progress tracking.

Enuresis often resolves spontaneously, at a variable pace, with a 15% annual resolution rate. More active treatments are recommended when it persists after age six or seven, especially when low self-esteem symptoms are present. Urine alarms (devices that help the child wake up when urination begins) or medications proven effective for enuresis may be indicated. In cases of enuresis with daytime symptoms (non-monosymptomatic), pelvic floor physiotherapy with biofeedback (a technique that teaches contraction and relaxation of pelvic floor muscles) and neurostimulation help the child control these muscles, improving the ability to store urine and empty the bladder effectively.

Treatment of other health conditions may be necessary. Medical guidance is always recommended for accurate diagnosis and to choose the best treatment for each case. At our facility, in addition to the specialist physician, we have a trained multidisciplinary team including a nurse, physiotherapist, nutritionist, and psychologist.

By Einstein Editorial Board