Urinary Accidents (Enuresis)
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Introduction
- These urinary (peeing) accidents can happen during the day or while the child is sleeping and are also referred to as bedwetting.
- Enuresis is common in young children.
- Many cases clear up by themselves as the child matures. However, bedwetting can last through the teenage years. Clients who experience bedwetting into adolescence should be referred to a medical professional for an evaluation.
Factors that may contribute to enuresis:
- Emotional stress.
- Medical issues.
- A genetic factor.
- Developmental delays.
- Child abuse.
- If you suspect the child is being abused or neglected, see Chapter D-3: Abuse and Neglect.
Enuresis can occur in any gender, but is more common in boys.
A child may lose bladder control after experiencing a stressful life event, such as:
- Loss of someone or something important. See Chapter D-22: Grief for more on helping children through losses.
- Substance use.
- Family conflict.
- Moving to a new home.
- Parental divorce.
- Exposure to traumatic events. See Chapter D-5: Trauma and Posttraumatic Stress for more on helping children through trauma.
Guiding Principles for a BHA/P
Express and demonstrate support for the child and caregivers. Remind children and caregivers that children develop urinary control at different rates. Encourage them that every child is unique and that there are ways to help children develop more bladder control.
Intentional wetting is not common. When it occurs, it can be a sign of emotional or psychological factors.
Urinary accidents are not usually done on purpose. Accidental urination can cause feelings of shame and embarrassment and interfere with the child’s school or social life. Shame may cause the child to lie about these accidents. Teach caregivers to speak in a way that does not reinforce the child's shame and instead helps the child let go of shame about this issue.
A medical health care provider can be helpful in ruling out:
- Child abuse. See Chapter D-3: Abuse and Neglect.
- Sexual abuse. See Chapter D-24: Sexual Aggression.
- Physical or medical problems.
- Developmental causes.
Many children can develop better bladder control with support, including the use of rewards for potty success. Medication is effective for some cases of enuresis.
Information You Need for This Visit
Referral information, including reports from medical providers, school staff, clinicians, or other sources regarding the client's wellbeing.
Releases of Information ( ROIs ) that are current or updated before getting information about the client from other sources.
Client history related to emotional stress, medical/physical concerns, being potty trained, developmental delays, family stressors, or child abuse.
Treatment plan, including a history of presenting problem and recommended course of treatment. Review the DSM-5 for criteria on Enuresis.
Signs, Symptoms, and Risk Indicators
Personal history
- A history of developmental delays or disabilities
- Verbal, physical, or sexual abuse
- Has been removed from home
- Low self esteem
- A recent major change, such as a move, loss of a family member, or parental separation
Behavioral factors after potty training is completed
- Urination in inappropriate places or at inappropriate times (age 5 and older)
- Frequent urinary accidents
- Fear or anxiety around using the bathroom
- Refusing to go to the bathroom
Physical factors
- Structural abnormalities in the child’s urinary tract
- No recent physical exam
- Reports or signs of child abuse Note: If you suspect the child is being abused or neglected, see Chapter D-3: Abuse and Neglect.
Family history
- Family members with enuresis history
- A family member who abuses substances
- Experienced trauma or loss
Symptoms of medical problems
- Pain or burning when urinating
- Difficulty urinating
- Excessive thirst
- Excessive urination
- Dark colored urine or blood in urine
- Unusual smell to urine
Evaluation Questions
These questions are written to be asked to the child. You can use the same list and reword the questions to ask the caregiver about the child. Consider asking these questions of the caregivers and child separately. The child may be reluctant to share the full extent and frequency of accidents in front of the caregivers. Parents and caregivers may also minimize the problem while speaking in front of the child.
Personal history
- Do you know how old you were when you were potty trained?
- How often do you have accidents?
- Have you seen a doctor about your accidents?
- Have there been any recent changes in your family or life?
- Are you ever scared to go to the bathroom?
- Are there times when you wait to go to the bathroom and then have an accident?
- Are there certain times of day or places where you have accidents?
- Has anyone else in your family had problems with accidents?
- Are the accidents more likely to happen when you sleep in or "hold it" during class?
- Do the accidents always seem to happen at the same time of day, after the same activity (such as drinking milk), or in the same place?
Interventions and Referrals
Routinely review Chapter C-4: BHA/P Services and Common Interventions for how to prepare for and conduct interventions during appointments and for information on the levels of service available throughout Alaska.
Specifically, you may consider individual counseling focused on:
- Improving self esteem.
- Managing stress or emotions.
- Changing behaviors and routines to reduce accidents.
- referral to medical provider for physical evaluation
Reporting and Documentation
Be sure you are familiar with the information in Chapter B-5: Mandatory Reporting and Duty to Warn and Chapter B-8: Documentation and Billing. Report instances of the following, consistent with your organization's policies and procedures:
- Child abuse or neglect.
- Suicidal thoughts or plans.
- Intentions to cause harm or injury to the self or others.
