Enuresis
Enuresis means literally "to make water." Treatments for enuresis have been found dating back to 1500 BC (juniper berries, cypress & beer). DSM-IIIR defines Enuresis as: A. Repeated voiding of urine during the day or night into bed or clothes, whether involuntary or intentional. B. At least two such events per week for up to three months. C. Chronological age at least five or equivalent developmental level. [Some clinicians prefer to wait until a chronological age of six or seven.] D. Not due to a physical disorder, such as diabetes, urinary tract infection, or a seizure disorder.

Enuresis is common. Prevalence for 5-year-olds is 15-20%, 10-year-olds, 5%, and 2% for children 12 to 14. Enuresis is more common in boys. There are three major theories to account for enuresis: medical-genetic, emotional disturbance, and failure to learn. While 90% of the cases of enuresis appear not to have a biological basis, this is the first level of assessment and intervention. Organic causes include: central nervous system lesions, disorders in neural innervation of the bladder, structural problems of the genital-urinary system, injury, infection and possibly food allergies. Theories dependent on the idea that emotional disturbance cause enuresis have lost popularity. However, it should be noted that many children with enuresis do suffer from emotional disturbance. In these cases it is typically not clear which factor is causal. Learning theories are dependent on the notion that the child has failed to master and control the urinary reflex. Interventions based on learning theory have been the most successful at treating enuresis.

Assessment of enuresis needs to include medical screening, clinical interview and a baseline recording. Patterns of diurnal and nocturnal wetting need to be evaluated. It is important to understand what the family has tried thus far and their understanding of the problem. The presence of psychopathology needs to be assessed. Many children will not respond to a treatment program for the enuresis until the psychopathology is addressed. It is important to listen to the child talk about the wetting. Are they afraid of the dark or the toilet? Is this a problem that they are interested in doing something about?

There are a wide variety of intervention strategies available: Psychotherapy, hypnotherapy, fluid restriction, drug treatment, urine retention and sphincter control exercises, dry bed training, and the urine alarm. Psychotherapy and fluid restriction are typically not very effective. Drug treatment can be effective. Behavioral programs based on a chart system, dry bed training, urine retention and sphincter control exercises and the urine alarm are all techniques based on learning theory. Techniques other than the urine alarm are best carried out by a behavioral specialist or individuals very familiar with the treatment protocols for these interventions. The urine alarm may be prescribed after the child and parents are thoroughly educated about their use. Patients need to be warned that relapse often occurs once the alarm is stopped, but brief reintroduction of the alarm often returns to child to having dry nights. Follow-up after an alarm is prescribed is advisable.

Alarm systems are available from medical supply stores and catalogues. An effective affordable system ($45.00) is available for Palco Labs, 1595 Soquel Drive, Santa Cruz CA 95065 (800) 346-4488. The Palco system, "Wet-Stop" eliminates the bulky pad and bell systems of years past. Tiny sensors are attached to the child's undergarments. The system also comes with an instruction booklet and chart system. Children that do not respond to the urine alarm system may need further medical and psychological evaluation.