Involuntary Urination in Children

Involuntary urination (or Enuresis) is a common problem seen in children. Parents are always worried for this problem of their children. Boys are more affected than girls. A positive family history also plays an important role in this problem.

Types

Nocturnal Enuresis – It is the condition of involuntary urination that occurs during sleep more than once a month. This is commonly seen in girls over 5 years of age and boys over 6 years of age. The basis for this condition may be psychogenic, neurology or anatomic.

Daytime Enuresis – This involves involuntary urination during the waking hours.

Primary Enuresis – It is diagnosed in children who report the problem for a long period of about 3-6 months. The reason for such condition is the reduced bladder capacity or frequent contractions of the bladder. Sometimes, the cause may be some food allergy or spinal cord malformation (though rarely).

Secondary Enuresis – It is the return of the involuntary loss of urinary control after a long period of controlled urination. Careful examination may reveal signs of spinal problem. Thorough neurological examination of the lower extremities and the genitals is mandatory in such type. Other cause may be bacterial infection, defect in renal tubules, glucosuria, pregnancy (or some other pelvic mass) and stress.

Other Symptoms

These may be dysuria (pain during urination) and increased intra abdominal pressure. Children with such problem often become withdrawn, shy or aggressive secondary to enuresis.

Investigations

Important historical information to be seeked includes age, type of enuresis, voiding pattern, any delay in the developmental milestones and toilet training techniques.

Other lab tests include urine culture, test for pregnancy, test for worm infestation and urinalysis (glucose, protein, specific gravity, microscopic examination). Special test is the estimation of the bladder size. Ultrasound and x-ray may be required in case of presence of urinary tract infection in association with enuresis. Observation of child’s urinary stream and force may also be helpful in diagnosis.

Treatment

Treatment measures include counseling and behaviour modification, toilet training, discouraging fluids during 2 hours before bedtime and encouraging the child to get up to urinate in the night. Act sympathetically with the child and never scold him for the act.

Bladder stretching exercises may be helpful. Bed-wetting alarms are also very efficient. Psychotherapy and reassurance is essential.

Since enuresis is self-limiting condition, harmful treatments are best avoided. However, in severe cases, the doctor may prescribe medications.