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Aspergers and Enuresis

"We have experienced unusual urination issues with our 'aspie' daughter. She wears pull-ups at night and has never had a dry night, but she will also urinate in containers, bags, purses and even in her play tea set. It doesn't happen as often any more, but has happened as recently as a month ago. She doesn't do it out of anger - it's more like a compulsion and she can't explain why she does it. (She also has a wide variety of other compulsive behaviors we're trying to work though.)"

Enuresis is diagnosed when kids repeatedly urinate in inappropriate places, such as clothing (during the day) or the bed (during the night). In most cases, the youngster's urination problem is involuntary in nature, and is perceived by the youngster as an unavoidable loss of urinary control.

There are three subtypes of Enuresis:

• Nocturnal (night-time) Only
• Diurnal (day-time) Only
• Nocturnal and Diurnal

The DSM criteria for diagnosis state that the urination problem (whether involuntary or intentional) must occur with regularity, at least twice a week, for three consecutive months before the diagnosis applies. The diagnosis cannot be made unless there is evidence that the urination problem causes distress or impairment in the youngster's social or academic functioning.

In Nocturnal Only Enuresis, the most common form of enuresis, kids wet themselves during nighttime sleep. Typically, wetting occurs during the first third of the night, but it is not uncommon for wetting to occur later, during REM sleep. In this latter case, kids may recall having a dream that they were urinating.

Diurnal Only Enuresis, where kids wet themselves only during waking hours, is less common than nighttime bedwetting. This type of enuresis is more common in females than in males, and is uncommon altogether after age 9. Kids who are affected by this type of disorder will typically either have urge incontinence (i.e., they feel a sudden overwhelming urge to urinate) or voiding postponement (i.e., they know they need to urinate, but put off actually going to the bathroom until it is too late).

As the name suggests, kids with Nocturnal and Diurnal Enuresis suffer from a combination of the two scenarios described above.

Predisposing factors that contribute to increased risk of developing enuresis include:
  • abnormal urinary functioning
  • delayed or lax toilet training
  • psycho-social issues (e.g., social anxiety)
  • reduced bladder capacity
  • unstable bladder syndrome (i.e., a condition wherein the youngster's bladder contracts involuntarily, resulting in sudden urine leakage)

Enuresis is most frequent in younger kids, and becomes less common as kids mature. According to the DSM, while as many as 10% of five year olds qualify for the diagnosis, by age fifteen, only 1% of kids have enuresis.

Enuresis is typically experienced as an embarrassing and shameful condition, particularly if the affected youngster is older. Kids with enuresis may be ostracized, teased and bullied by peers. In addition, they may face caregivers' anger, rejection and punishment for not meeting developmental expectations. Prompt treatment for enuresis can help to head off potential self-esteem problems associated with the condition.

Treatment involves a range of strategies including:
  • cleanliness training (kids help thoroughly clean the bedding and mattress when accidents occur)
  • family encouragement of good toilet habits and successful progress.
  • mild punishment (primarily disapproval when accidents occur)
  • nighttime waking (kids learn to wake themselves in the night to use the restroom)
  • positive practice (parents help their youngster to develop the habit of going to the bathroom at regular intervals during the day, just before sleep, and during the nighttime in order to avoid accidents)
  • positive reinforcement (rewards or praise) for urinating appropriately
  • urine retention control training (strategies to promote better bladder control)

Success rates associated with this Enuresis treatment appear to be around 85%, with relapse rates falling between 7%-29%.

Some physicians may suggest a pharmacological treatment for Enuresis. The most commonly prescribed drug is imipramine (Tofranil) which is an old-style tricyclic antidepressant. Imipramine treatment is often a successful treatment in the short term, with between 40 and 50 % of kids showing improvement. However, when the drug is discontinued, about 2/3 of kids show a relapse and begin enuresis behavior again.

Alternatives to antidepressant therapy for enuresis exist. Desmopressin (DDAVP) is a synthetic form of a natural pituitary antidiuretic hormone which reduces urinary production by instructing the kidneys to retain water inside the body rather than excreting it. Administering Desmopressin to kids reduces their urine output dramatically, making it easier for them to maintain continence. Between 10 and 60 % of kids with enuresis taking DDAVP show improvements. However, as is the case with Imipramine, relapses back into enuresis are common when the drug is discontinued.

Due to their better side effect profiles and longer lasting effects, behavioral treatments for enuresis are usually recommended over medical ones with rare exception.

The Aspergers Comprehensive Handbook

18 comments:

Anonymous said...

Have her checked for juvenile diabetes. This could be a sign! this happened to my neighbor she tried everything to stop him from peeing in inappropriate places all of a sudden.... he collapsed and was rushed to the hospital that when they found out it was not his ADHD causing the behavior.

Anonymous said...

I have to admit, it made me giggle a bit on the inside when I read the title simply because I knew exactly what you meant, but it's so frustrating and 'off' that I do my best to keep a sense of humor about it. My guy hasn't done it in a bit...oh, wait...he did pee in the driveway the other day - and was proud of it *sigh* but that was the first time in a long time. And really, in the list of things he has done...peeing outside or on the toilet seat is the least of my concerns - albeit annoying, and really gross at times. I was like you and totally on my last nerve - but then for some reason my attitude just switched, and I try to make it as much of a non-issue as possible - mostly cause the more I got upset, the more he did it - it was an attention grabber...the less I react - the less he does it...

Anonymous said...

My 5 year old son has been potty trained since he was two, now suddenly he has started to urinate in inappropriate places. He has never had any problems using the toilet or having accidents. He is usually well behaved, he's very smart, and mellow. It began with him starting to have accidents in his bed during the night. About a week later he started to pee in the playground in front of everyone at school. Within the last two weeks he has urinated inside his Aunt's closet, the backyard, his bedroom carpet, and even pooped outside on the patio! He is wetting the bed quite often now, even though he uses the bathroom before he goes to bed. He has been acting up at school and home. He admits to peeing everywhere and says he will stop, but it has not changed. We recently moved into a new house & his grandmother and aunt came to live with us. I do not know if the change has anything to do with this behavior or not.

Anonymous said...

I totally relate to your confusion! My 6yr old does that too!!! In really weird and inappropriate places and we just want to sit down and cry each time we see a new spot! I asked our pediatrician about it and he said it's from the impulse control problems associated with ADHD. We are in the middle of diagnosis with our son- and I’m hoping that with treatment (they've already recommended meds) the problem will stop.

Anonymous said...

Good luck with your little one- but just be reassured that you're not alone in this. On a different conversation a while ago- we mums were talking about this same phenomenon, and trust me- it happens quite allot!

Anonymous said...

My adhd son has only done this a couple of times at home........once in the dryer (luckily no clothes in it). However...when at daycare he and the daycare providers 3 year old would count to 3 and pee on each other.......they haven’t had this issue in quite a while, I think it’s under control. I did nothing to stop it....just didn’t draw a lot of attention to what he was doing and he forgot about doing it I guess.

Anonymous said...

My son is 6 yr old and ADHD. He is peeing in strange places, like the bathtub, behind the toilet, in storage containers, in the vents and many others. I DO NOT understand this. This is a child who has been WELL potty trained and has been for 2 years and there is very little to no bed wetting. But this seems to be escalating!!! WTF do I do to stop this??? I'm a girl so I wanted to put this off as a "boy" thing but......I AM AT MY WIT'S END!!!

Anonymous said...

My son was peeing in his garbage can, water bottles that he hid in his room, so we sat down with him and discussed the issue of his peeing, he said he "couldn't make it to the bathroom in the basement (our only bathroom currently), but let him know that he needed to use the bathroom not other places and as he has gotten older, the less he pees in strange places. Good Luck!

Anonymous said...

OMG that is so strange I have a 12yr old boy and he has started peeing around the house the other day it was in the bin but it was a wicker bin so obviously came straight out on to the floor he then decided to blame the Dog but as I Explained to him I haven’t got a dog only my sister one that comes round once in a blue moon so I knew it certainly wasn’t the Dog, I to don’t know how to Address this problem as nothing has changed in the house hold apart from him going back to school, but I don’t understand how or why they do these thing's !!!!!! Having Severe ADHD is one thing I have to deal with as I no he can’t help all he's bad behavior but I certainly cant tolerate the peeing everywhere and I really don’t know what to do or say to him as again all he says when he eventually admits it's him was, I don’t no mum I couldn’t get to the toilet in time as its too far, I live in a ground floor flat the toilet is nearby so there NO excuse !!!!!!!!! Please if anyone has any ideas then please do contact me and let me know as I’m at my wit's end with this and its a no winning battle.

Anonymous said...

One of my sons peed in weird places while sleep walking but not while away. I would suggest a talk with the pediatrician. There may be an underlying cause. You may also want to research side effects (the not so common ones) of any medications he's taking. Good luck and God bless.

Anonymous said...

Okay, so my son is daytime potty trained but apparently not housebroken lol . Saturday night, he peed in the bathtub (he was not taking a bath either), that afternoon he peed in our breezeway on the step to the kitchen door and yesterday I caught him peeing behind my daughter's bedroom door on some of her (thankfully old) shoes. Has anyone had this problem while potty training their boys? I can't understand what the deal is, he has always liked to go outside (I think all boys do) but this is a new one on me....

Anonymous said...

Im adult by law and have autism. Im having a kind of OCD which make me enuretic and encopretic. Each time I have sensory overload results in obsessive thoughts about doing it in my pants and so I do it to release my other discomfort. Im in therapy for it. It may be worth checking out if it can be something like this for your child too.

Anonymous said...

My 12 year old has PDD/Ausbergers. He started to urinate in strange places such as in corners of his room, in garbage cans, cups, plastic bottles, etc. It got so bad that we had to remove the carpet from his room because of the smell. I have tried everything to get him to stop and to no avail! He is on medication for bed-wetting and that has stopped but he still urinates everywhere else! I am so frustrated!!!! I've tried taking things away as punishment but he could care less!! I need help!!!!

Anonymous said...

My son wets himself when he has a meltdown, When he too busy with something to make it to the toilet and when he feels he is late for something and dosnt want to waste time. We found putting a large potty-type toilet in his bedroom (He is 6) he goes in it because it is next to him, At school the teachers are now telling him to go every half hour, so that he is always empty. Several occations he has wet in the car (only telling us when he is at extream level) and also several times at school . His teacher also has several set of pants for him in the cupbored, she has been a real help to him (adam)

Anonymous said...

My son is 6 years old and still has many urinary accidents and school, daycare and home. I am not sure what causes him to do this. He claims he was laughing or didn't know he had to go. I'm in the process of getting him tested by a psychologist due to behaviors at daycare, school and on the bus. They say he has a hard time paying attention and disruptive and so forth. He also had an ultrasound on his bladder and kidneys which turned out normal.

Andy Mees said...
This comment has been removed by the author.
Andy Mees said...
This comment has been removed by the author.
Unknown said...

My 12 year old son is pooping and peeing in cups,bottles,garbages. What can I do? He also hit my boyfriend, lies to manipulate, fights with 6 year old brother, wiped his hand on my boyfriend's face after he put it in his butt crack, won't wake up in morning for school, always breaking things, very argumentative, defiant. The list goes on. Help

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