According to the psychiatric classification of DSM-IV bedwetting (enuresis) is described by repeated voiding of urine into bed or clothes. It is important to find out whether this is involuntary or (very unlikely) intentional. To meet the diagnosis of bedwetting it must be clinically significant. It should be present twice weekly at least for three consecutive weeks and cause significant distress and impaired functioning. Most patients (80%) have nocturnal enuresis only. If enuresis has been present since birth (primary enuresis) organic factors (like urogenital problems, hormone deficits) are more likely. Secondary enuresis is any restarting bedwetting after the age of 5. Bedwetting can have a genetic cause and runs in families. Scientists think that there is a genetic link (chromosome 15). If one parent has enuresis there is 40% chance of enuresis for the child.
7 % of 5 year old boys and 3 % of girls meet this diagnostic criteria
at Age 10 about 3% of the boys are affected
At Age 18 is estimated that about 1% of the boys still meet this diagnosis.
First of all : It is important to rule out some organic disorders (like bladder dysfunction, infections, diabetes insipidus or diabetes). Some sleep disorders like sleep apnea can also cause enuresis.
Psychological / psychiatric causes should be carefully diagnosed by a specialist. Very often secondary problems of embarrassment or social anxiety are present and the adolescent or young adult is afraid to speak about his or her problem.
It is rather difficult to guess about all possible psychological causes of enuresis. Neglect or violence of any kind including emotional or sexual abuse and any kind of chronic distress due to family problems (divorce, loss of important persons, accidents) can be the origin. Some children feel responsibility for their siblings in case of sexual abuse. This could cause a severe traumatic experience or post traumatic stress disorder. Later in life any severe life stress or major changing of the personal environment can restart the problem.
But one should be very careful to adopt these hypotheses. If your son wants an evaluation he should seek professional help of a specialist. First he should rule out organic factors or his problem.
Treatment usually includes psychological help for coping and looking at the causes of the problems. Sometime additional medication is very helpful.