Methylphenidate for Giggle Incontinence

Purpose: Giggle incontinence or enuresis risoria is a socially embarrassing problem characterized by involuntary and complete bladder emptying in response to laughter. To our knowledge the cause of giggle incontinence is unknown, although a functional relationship to cataplexy was suggested. We retrospectively examined the effectiveness of methylphenidate for giggle incontinence in children. Materials and Methods: We retrospectively reviewed the charts of patients referred to a pediatric specialty voiding center between 2004 and 2008 for wetting associated with laughter. Patients who met giggle incontinence criteria with no associated urgency or urge incontinence were offered a trial of methylphenidate. Wetting frequency was assessed before and during methylphenidate treatment. Results: A total of 20 patients with a mean age of 12.4 years (range 7.5 to 15.5) met giggle incontinence criteria with no other wetting reported. Incontinence frequency was daily to less than once weekly. After a timed voiding trial 15 of 20 patients (75%) elected a methylphenidate trial, of whom 12 (80%) reported prompt and complete cessation of wetting. Treatment duration was 2 months to greater than 3 years. Conclusions: Giggle incontinence with no other urinary symptoms is a rare form of incontinence. Methylphenidate was a viable option for giggle incontinence but it was not accepted by all families.