Childhood Enuresis: Relationship to Sleep, Etiology, Evaluation, and Treatment

Enuresis is a common and often misunderstood condition that affects millions of children in the United States. For most children with primary enuresis, preventing secondary psychological sequelae associated with guilt and shame is an important consideration in deciding whether or not to treat. Because the spontaneous resolution rate is fifteen percent per year, the older the child, the more important treatment becomes. It is important to distinguish primary from secondary enuresis, since most psychogenically-induced enuresis is of secondary nature. A careful history can elicit the etiology, as well as the exacerbatory factors in both types of the condition, providing direction for treatment. Treatments include behavioral, pharmacologic, and psychotherapeutic approaches. In some cases, surgical intervention of either a urologic or otolaryngologic nature is indicated. A multidimensional treatment approach to this problem is described, together with its success rate.