Enuresis (urinary incontinence)

Knowing that your child is suffering from enuresis (urinary incontinence) can be upsetting. But you can rest assured that you’re in the right place. At Children’s Hospital Boston, we consider you and your child integral parts of the care team and not simply recipients of care. You and your care team will work together to customize a plan of care for your child.

And we can’t emphasize enough that your child will eventually learn how to stay dry — both during the day and at night.

Still, enuresis can be psychologically or socially difficult — both for your child and you as a parent — and it’s important to understand the condition and how it’s treated.

How is enuresis treated?

There are a few important things to remember before you start any kind of treatment:

• Enuresis at night without daytime symptoms occurs in up to 20 percent of children at the age of 5.
• Nighttime enuresis is typically due to difficulty with sleep arousal.
  • Most of the time, this gets better by adolescence.
• You shouldn't consider punishment or discipline, because your child can’t control the wetting. He is asleep!
• Enuresis usually goes away on its own in about 15 percent of affected children each year.

We’ve decided to begin treatment; what are our options?

Children's Department of Urology is home to a dedicated Voiding Improvement Program (VIP). VIP offers:

• customized treatment plans that take into account the needs and circumstances of the individual child and family
• comprehensive evaluations
• urodynamics and other tests
• a bowel program for children experiencing constipation
• counseling to reduce anxiety about voiding
• Biofeedback training, a non-invasive tool with excellent success rates
• Reiki therapy
• acupuncture

In addition, experts in Children's Developmental Medicine Center can help your child address emotional and psychological issues underlying his incontinence.

Your doctors and nurses will discuss with you an individualized course of treatment, but here are some general options:

Nighttime enuresis alarms — These small devices attach to your child’s clothing or bed and sound an alert when they come into contact with liquid. When the alarm goes off, you must go into your child’s room, wake him up and encourage him to use the toilet.

These nighttime alarms have proven to be very effective when used consistently. Nearly 75 percent of kids are dry throughout the night after three to four months.

Medications — If the nighttime enuresis alarm doesn’t work for your child — or if your child is in a situation where an alarm isn’t feasible (sleep-away camp, shared bedroom) — your doctor may prescribe an anti-diuretic hormone to help keep your child dry. Once your child stops taking the medication, the enuresis can return. Keep in mind, however, that most children will simply grow out of enuresis at some point in development.

Bladder training — You can do this at home with your child. Simply ask them to hold their urine as long as they can before going. Then, as they are going, ask them to stop, then start, then stop again.

This training can help increase the bladder’s capacity as well as your child’s ability to know when it’s time to urinate by helping them isolate the muscles involved in urination.