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ENURESIS - BEDWETTING

What is Enuresis ?

Enuresis is wetting in a child who has reached an age at which he or she would be expected to go to the toilet. It can occur at night or during the day. Enuresis is very common. By 3 years most children are dry by day, but many continue to wet at night. It is not unusual even for children of 5 or 6 to continue to be wet at night. Older children may keep it a secret, but 1 or 2% go on being wet at night until they are teenagers. Children with delayed development or disabilities may become dry later than others.

How does Enuresis occur ?

As they get older, children become conscious of the state of their bladder. They are then able to hold urine in their bladder, wake up at night and realise that they need to pass urine. For children who bed wet there is a delay in the maturing of this system. Development is normal in all other ways and the problem mostly goes away as they grow up.

Why does Enuresis occur ?

The most common reason is a delay in the development which allows them to know that they need to pass urine at night. The problem is commoner in boys and may run in families. If a child has been dry and starts to wet again, it may be caused by a change in their routine (such as a new school, a new baby) or an upsetting event. Urine infection, and some other problems such as diabetes can cause a child to suddenly start wetting.

Treatment Involved for Enuresis

A urine test may be sent to make sure there is no infection or diabetes present. It is usually not necessary to carry out any other tests. If the child is younger than 6 years the problem is likely to resolve with time and no action may be needed. Older children can also be reassured that the problem is likely to go with time. A plastic mattress cover may be helpful. There are a number of ways of treating the problem: Positive support Encouragement and reward for dry nights is more likely to succeed than punishment for wet nights. Praise the child if they manage a dry night and try to remain calm about the wet ones. It can be very difficult not to get angry with a child who wets but this may make the problem worse. It may also make things worse if the child is teased at school about it.

One way of supporting the child is to use a “star chart”. Use a calendar and give the child a coloured star to stick on for every dry night. Give a reward for a number of dry nights. Giving a small reward for a few dry nights is more likely to be successful than offering them a big present if they stop wetting completely. Lifting at night Some parents find it helps to get the child up to go to the toilet later in the night. Fluid restriction Trying not to let the child drink a lot of fluid before bed can help. Buzzers and bells There are a lot of different pieces of equipment available. A sensitive pad in the bed or in pyjamas sets off a bell or buzzer when it gets wet with urine, and the child is woken up. The idea is that the child comes to associate the feeling of being about to pass urine with waking up. While this can be effective in some older children it will not help everyone. It is not likely to help children less than 8 or 9 years old. Children who wet the bed frequently may sleep very deeply- they may not wake up, but everyone else in the house might! Drugs Unfortunately there is no medicine which cures the problem. There is a nasal spray called desmopressin, which cuts down the production of urine. It will reduce bedwetting while it is used. This can help for school trips and visits to friends.

During Treatment for Enuresis

Ask your doctor for advice if the problem does not go away or seems to get worse.

After Treatment for Enuresis

Children may continue to have occasional “accidents”, particularly if they are tired, ill or unhappy.

If Enuresis is Left Untreated

Wetting usually goes away by itself in time.

Effects on Family of Enuresis

Try not to get angry or fight with the child, although this can be difficult. Remember that the child is not to blame for the wetting. Bedwetting can be very difficult for brothers and sisters if they share a bedroom.