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WHAT  IS  ENURESIS?

 

Enuresis is the medical term for an inability in children to control urination. Bedwetting at night is known as nocturnal enuresis and can be caused by a range of factors.

 

When young children are awake, they gradually learn to recognise signals from the bladder. Thus most children become dry during the day relatively easily.

 

When the child is asleep, urinary control has to be carried out subconsciously, and bedwetting continues until the brain learns to recognise the signals from the bladder.

 

Nocturnal enuresis is divided into two groups; primary nocturnal enuresis occurs when bladder control has never been acquired; secondary nocturnal enuresis when bladder control has been gained and lost.

 

A child who wets the bed may be insecure and upset. Be sympathetic and patient with your child and remember that it is not her fault.

 

What age group is affected

 

Enuresis is diagnosed when a child over the age of five, with no other health problems, wets the bed at least once a month.

 

Nocturnal enuresis affects about one in six children over the age of five. By age seven only about one in 10 children still wets the bed, and this reduces to one in 20 by the age of 10. Bedwetting can carry on into the teenage years (one in 40) and even adulthood.

 

Daytime enuresis is less common, affecting about one in 75 children over the age of five, because children learn to recognise bladder signals  when they're awake.

 

Boys often take longer than girls to learn bladder control

 

Contributing factors

 

There may be factors in a child's life that can delay the acquisition of bladder control or trigger secondary enuresis

 

• Children with small bladders are more likely to have accidents at night until their bladders have fully expanded. 
• Major changes, such as a new brother or sister or moving home or school, can cause anxieties that may subconsciously trigger enuresis. 
• Situations, such as emotional difficulties in the home, can result in psychological problems that may trigger enuresis. 

The causes of enuresis

 

Despite a considerable amount of research, the causes of enuresis are not fully understood.

 

Hereditary: bedwetting can run in families because a deep sleep disorder can be inherited. In very deep sleep, the brain does not respond when signaled by the bladder. The sphincter muscle around the opening of the bladder remains relaxed and the bladder empties involuntarily. Consequently, the bladder develops a small capacity and the sphincter muscle remains weak.

 

Physiological: although rare, disorders that can result in enuresis include anatomical abnormalities and infections of the urinary tract, and abnormalities of the nerves that control the bladder. Constipation and untreated diabetes can also be a cause.

 

Treating Enuresis

 

In most cases, bedwetting stops without treatment. Medical treatment is unlikely to be recommended for a child under six.

 

• After the age of six special tests on bladder function may be carried out to establish that the nerves and muscle are working normally. 
• Bedwetting alarms are triggered by a few drops of urine and wake the child. They are considered by most specialists to be an effective way of training a child. Alarms are said to cure 70 per cent of cases, only 10 per cent of which return to bedwetting after the alarm has been removed. 
• Behavioural therapy, such as praise and reward for dry nights, is often used and is good for your child's self-esteem. However, it is not thought to be as effective as a bedwetting alarm. 
• In rare cases medicines can be given, but most children start bedwetting again after a drug is withdrawn. A hormone tablet or nose spray which helps to cut down on urine production may be used. 

Helpful measures

 

There are a number of precautions that can be taken, if your child is happy with them,

 

• If possible, try to ensure that your child avoids drinking fluids for a couple of hours and empties his bladder before going to bed. 
• Protect the bed by using a waterproof mattress or a fitted waterproof mattress cover fastened securely to prevent any danger of suffocation. 
• Leave clean night­clothes and sheets near the bed, so that they can be changed if the child wishes to do. 

Who can help?

 

If bedwetting becomes a problem and you feel you need help, it is almost certainly available somewhere near you.

 

• Many districts have enuresis clinics, which specialize in the treatment of bedwetting. 
• Your health visitor should be able to offer advice and in some areas there are specialist nurses and doctors who can visit people at home. 

Dos and Don’ts

Children do not wet the bed on purpose. It is not due to laziness or a lack of willpower, and a child should not be disciplined when he has an accident.

 

• Do not scold or punish the child or in any way make him feel that he is to blame.
• Do not put a nappy on the child at night, as this may reduce his awareness of the problem. 
• Do not make the subject a big issue in the family; instead, treat it in a matter-of-fact way. Some children gain pleasure from the attention given as a result of bedwetting, even if the attention is negative. 
• Do let your child know that bedwetting is very common and is nothing to be embarrassed about. If other members of the family suffered from enuresis in the past, tell the child about their experiences. 
• Do praise your child for going through the night with a dry bed, but don't over stress the praise, as this can reinforce the idea that bedwetting is a cause for shame or embarrassment. Some parents ask their child to keep a chart, offering a small reward for dry nights. 
• Do praise your child in other areas of his life, to help him feel better and more positive. Bedwetting can cause a child to develop low self esteem. 

For  More  Information:  Please  consult  your  physician  on  your  next  visit.