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Background
The purpose of reviewing this case is to highlight that a regular behavioural modification therapy can improve enuresis symptoms, without using specific medication.
Enuresis is defined as the failure of voluntary control of the urethral sphincter. If a child has never been able to reach an adequate sphincter control in the past we refer to it as primary enuresis. 1 The prevalence of enuresis is 15-20% in the child population; however, children with ADHD had a 2.7 times higher incidence of enuresis and a 4.5 times higher incidence of daytime enuresis. In the USA, enuresis affects 5-7 million children. 2 - 8
Some researchers support the hypothesis that primary nocturnal enuresis is a heterogeneous process, and that genetic heterogeneity may be reflected in some of the comorbid clinical conditions such as attention-deficit and hyperactivity disorder. 5 7
Bedwetting or enuresis is a common cause of isolation in children. They may avoid certain social situations, like overnight camps and slumber parties. Bedwetting can cause real problems such as loss of self-esteem and other psychological distress for the child and the family. The most important reason for treating enuresis is to minimise the embarrassment and anxiety of the child and the frustration experienced by the parents. 7 9
Preliminary management focusing on behavioural modification and positive reinforcement is often helpful. The only therapies that have been shown to be effective in randomised trials are alarm therapy 10 and treatment with desmopressin acetate or imipramine. 11 12 Most children with enuresis feel very alone with their problem, like they cannot talk to other people about it. Family members with a history of enuresis should be encouraged to share their experiences and offer moral support to the child. The knowledge that another family member has had enuresis and has outgrown the problem can be therapeutic. 7
Case presentation
This case study involves a 6-year-old child born in Barcelona (Spain) who received follow-up treatment in a childhood psychiatry unit for the past 1 year due to behavioural disorders, and ADHD. The patient also suffered from primary enuresis wetting his bed approximately 2 nights/week. He was being treated with methylphenidate 10 mg/day. To treat his enuresis disorder, positive...