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BED-WETTING

Bed-wetting has plagued parents and children for many millennia. A treatment for enuresis, which is defined as involuntary discharge of urine, was described in an Egyptian papyrus in 1550 BC. It probably didn’t work.

Most of the bed-wetting parents worry about is not enuresis because it occurs in young children. The term nocturnal or sleep enuresis (involuntary discharge of urine during sleep) is reserved for boys over age 6 and girls, who generally achieve bladder control earlier than boys, over age 5. Children younger than this who wet at night are exhibiting normal behavior. . .although the bed is just as wet!.

What do we know about bed-wetting in children old enough to warrant using the term? It is fairly common, affecting about 20% of 5-year olds, 4% of 10 year olds and 1% of 18-year olds. Bed-wetting is more common in boys than in girls and it runs in families. The risk that the child will be affected increases sixfold if the mother or father was a bed-wetter. Also children with a family history of bed-wetting took an average of one-and-a-half years longer to achieve nighttime bladder control than did children without such a family history.

An annoying disorder as common as enuresis is bound to lead to many folk remedies as well as many theories as to what causes it. Although once thought to be a sleep disorder with a defective arousal mechanism, recent studies have disproved this theory by showing that bed-wetting is independent of sleep stage. Some doctors postulated a defect in the size or efficacy of the bladder but this is not the case. There are always some experts who believe there is a psychological component to everything–the child wets the bed to get even with his parents sort of stuff.

The latest research points to nighttime urine production as a cause of nocturnal enuresis. We know that the bladder has to be full for enuresis to occur. Evidently some children who wet the bed have not developed a normal nocturnal anti-diuresis mechanism. This means that, unlike the rest of us, these children do not decrease urine production at night. The amount of urine they produce at night far exceeds their daytime bladder capacity.

What is a parent to do until their child develops the ability to produce less urine at night?

There is absolutely NO evidence at all that punishment works. Punishment for something the child cannot help seems cruel yet one-third of parents queried “treat” bed-wetting with punishment. Waking the child to go to the bathroom or withholding fluids after a certain hour don’t help either.

When my own children were trying to stay dry, I left a light on in the bathroom, dressed them in loose, easy-to-get-out of pajamas, folded a thick towel on the bed, and left another pair of pajamas and folded towel within reach. If the child had an accident it was a simple thing to change and put the wet towel in the hamper and the dry towel on the bed without waking up the parents. This helped give the child a sense of mastery over the situation.

What can be done for the child over 5 who has nocturnal enuresis? One approach is to do nothing and wait for the child to outgrow it. This is fairly effective. A bed-wetter has about a 15% chance of the problem going away during the course of a given year which means that the vast majority of children stop wetting the bed before they are in their teens. If the parents and child can tolerate the extra laundry and the stigma, it’s OK to wait patiently.

However, many children are troubled by the fact that they cannot control their bladder at night although their friends can. They are ashamed to sleep over at a friend’s house. Children themselves interpret the bed-wetting as “babyish.” Studies have shown that measurements of children’s self-concept increased after enuresis was treated.

If parents decide to help their child get over this problem, there are two forms of treatment to consider: conditioning (behavior modification) or pharmacological (drug) treatment.

Conditioning therapy involves buying a urine alarm, a device that sounds a buzzer when the child first begins to void. The child gradually is conditioned to awaken when the bladder is full. This method works. There is about a 70% success rate and a low relapse rate after the treatment is stopped.

Imipramine (Tofranil) is an antidepressant drug which works in some cases of enuresis. Success rates approach 40% and other children improve though they are not cured. Desmopressin also can help as it acts like the antidiuretic hormone which these children lack. Success rates approach 55%

If your child wants help with bed-wetting, start with a visit to the pediatrician to make sure the child is healthy and to talk about a therapy. If it were my child I’d try the urine alarm because it has the best cure rate, the lowest relapse rate, and no drug side effects. However if this didn’t work, I would not hesitate to use either imipramine or desmopressin under careful medical supervision. Be sure the child understands that he or she is going to the doctor for help with a problem, not because the child is bad or acts like a baby or because the parents are upset.

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