Fact Sheet: Enuresis in Children and Adolescents

Enuresis involves the repeated voiding of urine during the day or at night into bed or clothes. Usually this is involuntary, but occasionally it may be intentional. To qualify for a diagnosis of enuresis, the voiding must occur at least twice per week for at least 3 months or else must cause clinically significant distress or impairment in social, academic, occupational or other important areas of functioning. The child must have reached an age at which continence is expected, typically age 5.

Prevalence and Course

The most comprehensive epidemiological survey of enuresis is the National Health Examination Survey, which reported that as many as 25 percent of boys and 15 percent of girls were enuretic at age 6 with as many as 8 percent of boys and 4 percent of girls still enuretic at age 12. Although enuresis can impose social and psychological burdens on afflicted children and their families, it is, in itself, a relatively benign condition and one that will resolve in most cases, even without treatment. A 15 percent spontaneous cure rate is well documented.

Health and Psychosocial Consequences

There are no significant health-related consequences of enuresis, although the presence of enuresis could be a marker for medical conditions such as urinary tract infections or vesicoureteral reflux. Other psychosocial consequences result from the shaming, blaming and characterological attributions that are directed at incontinent children in addition to an increased risk of child abuse secondary to incontinence.

Evidenced-based Assessment

There are no widely used evidence based assessment tools focused solely on enuresis. However, measures such as the Dysfunctional Voiding Scoring System allow for an objective assessment of enuresis and other co-morbid voiding and/or elimination symptoms. Most research focused on assessment has utilized instruments that incorporate enuresis based items into a larger constellation of items focused on broad psychosocial issues. As for enuresis itself, there are two primary domains of assessment, wet or dry days (or nights), and size of urine spot.

Cultural, Diversity, Demographic and Developmental Factors

The prevalence of enuresis appears to be consistent across races with differential rates for gender as indicated above. The impact of race on prevalence and course of enuresis has actually received little research based attention and could be characterized as an important gap in knowledge. There is some speculation that diminished social resources may be correlated with elevated prevalence of enuresis. Developmental factors are important; urinary continence is correlated with development and therefore delays in development have a virtual isomorphic relationship with delays in its attainment. In fact, some of the most influential treatment based research on enuresis utilized adults with developmental delays.

Evidence-based Interventions

Evidence-based treatment for enuresis involves use of the urine alarm, typically accompanied by other components such as a waking schedule and urine retention training. The success rate of alarm based treatment is higher and its relapse rate lower than that of any other method. In addition to Kegel exercises and timed toilet visits, the urine alarm has also been shown to be beneficial for children with diurnal enuresis.

References

Christophersen, E. R., & Friman, P.C. (2010). Encopresis and enuresis. Cambridge, MA: Hogrefe. 

Farhat W., B├Ągli D.J., Capolicchio G., O'Reilly S., Merguerian P.A., Khoury A., McLorie G.A. (2000). The  dysfunctional voiding scoring system: quantitative standardization of dysfunctional voiding symptoms in children. Journal of Urology, 164, 1011-1015.

Friman, P.C. (2007). Encopresis and enuresis. In M. Hersen (Ed. In Chief) & D. Reitman (Vol. Ed.), Handbook of assessment, case conceptualization, and treatment: Vol 2:  Children and adolescents (p. 589-621). Hoboken, NJ:  Wiley.

Friman, P.C., & Reimers, T. (2012). Enuresis and encopresis. In E. Szigethy, J.R. Weisz, & R.I. Findling (editors), CBT for children and adolescents (pp., 467-512).  Arlington, VA: American Psychiatric Association. 

Mellon, M.W., & McGrath, M.L. (2000). Empirically supported treatments in pediatric psychology: Nocturnal enuresis. Journal of Pediatric Psychology, 25, 193-214.