A preventive context for enuresis.

Prevention of enuresis has not been studied directly. Positive results from a randomized clinical trial evaluating early intervention for children at risk for enuresis would establish the value of prevention and help to promote its practice. Enuresis is not a disease process, and therefore a clinical trial may never be conducted, but the treatment of enuresis can be a threat to the child's health, as can the parental, professional, and peer response to the wetting. Children cannot die from wetting the bed. They can die from the medicine given to them to stop the bed wetting. Wet beds cannot cause contusions, abrasions, and concussions. Punishments administered for bed wetting can. Urine cannot cause emotional disturbance. Ridiculing, admonishing, or singling out a child for urinating can. Numerous suggestions are available to help to prevent the problems linked to enuresis, and perhaps to prevent enuresis itself. They range from the simple (e.g., waiting for the problem to resolve itself) to the very complex (e.g., promoting a change in the DSM-III criteria). The preventive suggestions in this paper are by no means exhaustive. Rather, they are an example of suggestions that can come from the literature on each aspect of enuresis: diagnosis, incidence, etiology, and treatment. A review of this literature reveals that, no matter which aspect of enuresis a researcher investigated or which body of findings a clinician examined, increased prevention could be the outcome. Child health should be the provider's abiding concern when choosing a treatment for enuresis. Management by parents and health care providers constitutes the primary threat that enuresis poses to emotional and physical health. Historically, the choice of treatment was governed more by the possibility of continence than by possible side effects on child health. The decision to use a treatment should be guided by the pediatrician's assessment of the child's readiness, willingness of the child and parents, and family resources. Although treatment is evolving, some interventions are highly rigorous and appear to focus primarily on dryness (e.g., the original dry-bed training). Treatment for enuresis has not yet been conceptualized into an encompassing context of health as have other medical maneuvers (e.g., physical examinations are now part of health maintenance). Enuresis is a presenting complaint that is not of itself a threat to health. Prevention, therefore, is its most appropriate context, and the pediatrician is the primary promoter of that context.