ENURESIS

It is defined as an inability to control urination.
1.Nocturnal enuresis (bed wetting).
2.Diurnal enuresis
Nocturnal Enuresis (bed wetting) 
It is involuntary urination while asleep after the age at which bladder control would normally be anticipated. Bed-wetting is fairly common and is often just a developmental stage. Bed-wetting is more common among boys than girls.

1.Primary Nocturnal Enuresis- It is refers to inability to maintain urinary control from infancy. It is the most common form of bedwetting in childhood.
2.Secondary Nocturnal Enuresis- It occurs after a patient goes through an extended period of dryness at night (roughly 6 months or more) and then reverts to nighttime wetting. Secondary enuresis can be caused by emotional stress or a medical condition, such as a bladder infection.

Causes:
Some of the causes of bed-wetting include the following:
1.Genetic factors (it tends to run in families)
2.Difficulties waking up from sleep
3.Stress
4.Slower than normal development of the central nervous system (which reduces the child's ability to stop the bladder from emptying at night)
5.Hormonal factors (not enough antidiuretic hormone is produced, which is the hormone that slows urine production at night)
6.Urinary tract infections
7.Abnormalities in the urethral valves in boys or in the ureter in girls or boys
8.Abnormalities in the spinal cord
9.A small bladder
Bed-wetting is not a mental or behavior problem. It doesn't happen because the child is too lazy to get out of bed to go to the bathroom.
Diurnal Enuresis (daytime wetting)
It is defined as involuntary voiding beyond the age of anticipated control. Children with daytime wetting may have frequent urination, have urgent urination or dribble after urinating. Daytime wetting is more common in girls than in boys.

Causes:
Common causes include, but not limited to:
1.Incomplete emptying of the bladder
2.Irritable bladder
3.Constipation
4.Stress
5.Urinary tract infection
6.Urgency (not "making it" to the bathroom in time)
7.Anatomic abnormality
8.Poor toileting habits
9.Small bladder capacity
10.Medical conditions like overactive bladder disorder

Diagnosis:
Enuresis is most often diagnosed in children because the parents express concern to the child's doctor. The pediatrician or family physician will give the child a physical examination to rule out medical conditions that may be causing the problem, including structural abnormalities in the child's urinary tract. The doctor may also rule out a sleep disorder as a possible cause.
Urine Examination has to be done to rule out any infection and diabetes.
Doctor may also ask about how things are going at home and at school for the child. Studies have shown that children who wet the bed are not more likely to be emotionally upset than other children. Doctor will also ask about your family life, because treatment may depend on changes at home.

Treatment:
After clinical investigation, if any pathology is present then the line of treatment will be according to that.
Most children outgrow bed-wetting without treatment. Children achieve bladder control at different ages. By the age of 5 years, most kids no longer urinate in their sleep. When bedwetting continues to age 5 (or at any age if it is troublesome to the child) it is time for treatment to stop it permanently.
Child can be treated with behavior therapy and medicine.
1.Behavior therapy helps teach your child not to wet the bed. Some behavioral treatments include the following:

• Alarm system that rings when the child wets bed. 
• Reward for dry nights.
• Asking your child to change the bed sheets when he wets bed.
• Having your child practice holding his or her urine for longer and longer times i.e. bladder training.
• Have your child go to the bathroom at the beginning of the bedtime routine and then again right before going to sleep.