Enuresis

Enuresis refers to a condition in which a child is unable to control bladder function, even though the child has reached an age at which  control of voiding is expected or the child has successfully completed a bladder control program.

By the age 5 years, most children are aware of bladder fullness and are able to control voiding. Enuresis is present in 3 to 10 present of school children. Bed-wetting does decreases as they reach adolescence.

Primary nocturnal enuresis

• Primary nocturnal enuresis is bed-wetting in a child who has never been dry for extended periods.
• The condition is common in children, and most children eventually outgrow bed-wetting without therapeutic intervention.
• The child is unable to sense a full bladder and does not awaken to void.
• The child may have delayed maturation of the central nervous system.
• The child should be evaluated for any pathological causes before the diagnosis of primary nocturnal enuresis is made.

Secondary or acquired enuresis

• The onset of wetting occurs after a period of established urinary continence.
• Secondary enuresis may occur during nighttime sleep (nocturnal), only during the waking hours (diurnal), or during daytime and nighttime.
• The child may complain of dysuria, urgency, or frequency.
• The child should be assessed for urinary tract infections.

Causes

• Some of the causes of enuresis are lack of toilet training, too early or too severe training, overtraining, or an organic problems.
• The child may have an irritable bladder that cannot hold large quantities of urine, a neurologic defect, or a urinary tract infection.

Treatment

• Children with enuresis need support and understanding. Embarrassment and frustration are frequently present in these children and their families.
• The nurse should advise parents that critical comments may cause low self-esteem. Parents should give children a role in the management of the problem. 
• Perform urinalysis and urine culture as prescribed to rule out infection or an existing disorder.
• Assist the family with identifying a treatment plan that best fits the needs of the child.
• Limit fluid intake at night, and encourage the child to void just before going to bed.
• Involve the child in caring for the wet sheets and changing the bed to assist the child to take ownership of the problem.
• Provide reward systems as appropriate for the child.
• Incorporate behavioral conditioning techniques.
• Encourage follow-up to determine the effectiveness of the treatment.