Enuresis (urinary incontinence)

All kids have accidents as they’re learning how to listen to their bodies and use the toilet. For some children, however, enuresis (urinary incontinence) can be more than just an occasional problem.

The good news is that enuresis goes away on its own in about 15 percent of affected children each year. Add some of Children’s Hospital Boston’s expert advice and treatment and that number gets much higher.

Our physicians and nurse practitioners are experts in helping kids learn how to stay dry both during the day and at night. We’ve had years of experience treating kids just like yours. So take a deep breath and try not to worry — your child will be just fine.

Read on to learn more about enuresis and what it means for your child.

How many kids does it affect?

Quite a few. Enuresis can affect up to 20 percent of first-grade boys and 17 percent of first-grade girls.

What is the long-term outlook for my child?

Though it may seem as though your child will suffer from enuresis forever, this isn’t the case. The vast majority of kids (the possible exceptions being those who have an underlying medical issue) will eventually stay dry both during the day and at night.

And keep in mind that enuresis goes away on its own in 15 percent of kids each year. So the older your child gets — even if you elect to have no treatment at all — the more likely he is to stay dry.

We know this is a frustrating time, but we’ve seen many, many kids who’ve had this problem — and we’ve helped them (and their families) get through it.

Causes

What causes enuresis?

There are many factors that may be involved, and many theories that are given for why children wet. The following is a list of some of the possible reasons for the problem:

• small functional bladder capacity
• difficulty with sleep arousal or the presence of a sleep disorder
• a problem with the proper functioning of hormones that help to regulate urine volume
• genetics — enuresis tends to run in families
• delay of your child’s body’s ability to hold urine — this may be a factor up to about age 5
• constipation — backed-up stool in your child’s intestine can push against the bladder, causing accidental urination

It’s also possible that other medical conditions may be causing your child’s enuresis:

• urinary tract infection
• diabetes
• sickle cell disease

Diurnal enuresis can also be caused by problems of inattention in a child who is very active and may not want to slow down or stop playing to use the toilet

Symptoms

What kind of other problems might my child have?

While enuresis doesn’t cause any physical problems (with the possible exception of a rash from consistently wearing wet underwear), it can cause your child to have emotional problems.

Your child might feel emotionally upset by soiling her clothes or her bed, leading to feelings of shame and embarrassment.

You, too, might feel guilt, shame and anger from your child’s enuresis. It’s very important to try not to communicate this to your child, as this may worsen her emotional state.

Is enuresis painful?

No. Enuresis doesn’t hurt your child.

FAQ

Q: What causes enuresis?
A: There are many factors that may be involved, and many theories that are given for why children wet. Possibilities include:

• small functional bladder capacity
• difficulty with sleep arousal or the presence of a sleep disorder
• a problem with the proper functioning of hormones that help to regulate urine volume
• genetics — enuresis tends to run in families
• delay of your child’s body’s ability to hold urine — this may be a factor up to about age 5
• constipation — backed-up stool in your child’s intestine can push against the bladder, causing accidental urination

Q: How many kids does it affect?
A: Quite a few. Enuresis can affect up to 20 percent of first-grade boys and 17 percent of first-grade girls.

Q: What treatments are available?
A: Possible treatments include nighttime enuresis alarms, medications, bladder training and positive reinforcement. And for children who still have trouble staying dry, Children’s has created the Voiding Improvement Program (VIP)

Questions to ask your doctor

You and your family are key players in your child’s medical care. It’s important that you share your observations and ideas with your child’s health care provider and that you understand your provider’s recommendations.

If your child is suffering from enuresis and you’ve set up an appointment, you probably already have some ideas and questions on your mind. But at the appointment, it can be easy to forget the questions you wanted to ask. It’s often helpful to jot them down ahead of time so that you can leave the appointment feeling like you have the information you need.

You may want to suggest that your child write down what he wants to ask his health care provider, too. Some of the questions you may want to ask include:

• Does enuresis go away on its own?
• What are our treatment options?
• What kind of alarm would you recommend?
• Are the medications safe?
• What are some good positive reinforcement strategies?
• What can we do at home to help?
• Where can we go for further information?

Keep in mind that your doctor will want to ask you some questions, too. These can include the following:

• How long has your child had problems with enuresis?
• Has your child been toilet trained?
• Have you tried a nighttime enuresis alarm already?
• Have you tried any medications?
• Is there a history of enuresis in the family?