What is Enuresis?
Enuresis (bed wetting) can be described as the involuntary discharge of urine during sleep (nocturnal enuresis). It is given this name only after the age at which bladder control should be established. This process is usually evident in children by the age of five years old. If a child has never been totally dry through the night for a year, the condition is known as primary nocturnal enuresis. If a child has been totally dry for a year prior to the problem appearing, this is secondary nocturnal enuresis.
Parents worried about their child's bed wetting should consult their doctor. It is rare for a child who has enuresis to have any underlying illness, but other possibilities such as diabetes, infections or abnormalities will need to be ruled out first.
It is extremely important that a child is given reassurance that he or she is not ill and that there is a solution to the problem. Any signs of improvement should be praised and they should never be blamed, criticized or punished for bed wetting.
To be classed as enuresis, a child over the age of five would have to involuntarily lose control of their bladder function at least twice a month. There are several factors which may contribute to enuresis.
- A family history of enuresis
- A stressful life event
- Urinary tract infection
- Chronic constipation
The first approach would be behavior therapy for nocturnal enuresis. In order for this to be successful, a child needs to understand how to do what you are asking and be motivated enough to do so. Punishment should never be used for bed wetting. General approaches are listed below:
- The child should urinate before bedtime. Remind the child to get out of bed if they feel they need to.
- The bathroom should be easily accessed and have a light on. A potty can be provided in the bedroom, if required.
- Nappies / diapers should not be used at night; a plastic mattress protector should suffice.
- Leave a spare pair of pajamas out for easy access. If an accident occurs, the child can change without any fuss. Place dry towels over the wet spot to avoid changing the bed sheets through the night.
- On waking in the morning, the child should get changed and remake the bed before taking a shower.
- Rewards should be used for dry nights. The results of this reveal an improvement 75 percent of the time. Let the child pick the reward beforehand.
- A record should be kept of the child's fluid intake, bearing in mind that no more than ⅕ of it should be taken in the evening.
- There are also medications which can be used under the supervision of a physician, but this should be a last resort when all other methods have failed.
There is also a device called an Enuresis Alarm, which can be used to help a child develop a better response to a full bladder. When the child starts to wet the bed, a moisture sensor sends a signal to a control panel which in turn sounds an alarm. Some alarms also vibrate, which is very useful for a child with a hearing impairment or for those who sleep in a room occupied by others.
Not only does the alarm wake the child, who would then get up to go to the toilet, the alarm stimulates the child's pelvic floor muscles to contract and so control the flow of urine. This becomes a conditioning process and the child wakes before the alarm sounds – or ends up sleeping through the night without needing to urinate. It is not usually recommended for a child to start using the alarm until they are at least six or seven years old as they need to be old enough to understand the problem and how to become involved in treating it themselves.
Success is more likely in a well-motivated child and by giving the child responsibility for how the problem is treated as well as praising them when there are signs of progress. Complete dry nights do not occur straight away. It does take time but with the right support and praise, relapses are very unlikely.
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