Bed-wetting

Nocturnal enuresis, also called bedwetting, is involuntary urination while asleep after the age at which bladder control usually occurs. Bed wetting is considered normal till the age of 5 to 6 years. Most of the children are dry at this age. But some children continue to bed wet.

Understanding Your Child, Yourself, and the Situation

There are many reasons for bed-wetting. Bed-wetting can be the result of a developmental issue, a physical condition, a sign the child is being sexually or physically abused, or it can be a mistaken goal.  The first thing to do is have a through medical checkup to see if the problem is physical or developmental.

Few tips:

1. Take a look at what you might be doing to create the need for undue attention, power struggles, revenge cycles, or helplessness. Many parents of bed-wetters create this problem by nagging, reminding, coaxing, and trying to control the child's bladder. Stop! Instead spend special time with your child. 

2. If your family is going through a change that might create stress, such as the birth of a baby, moving, or a new job, spend extra time with your child to increase her sense of belonging and significance. The bed-wetting will stop when she feels secure.

3. Decide what you will do instead of trying to control what your child does. You might want to cover the mattress with a plastic sheet.  

4. Instead of compounding the problem by using humiliation, get into the child's world. Ask the child how she feels about the problem, and how it is for her to have this happening. Ask if your child needs help or can handle it by herself. Listen respectfully to what she says.

Prevent Future Problems

1. Do not attempt toilet training too early. This invites behavior problems. We suggest waiting until   your child is at least 18 month old. Toilet training can be started between 18 month to 36 months.   

2. To avoid behavior problems, take time for toilet training . 

3. Share respectful stories about bed-wetters so your children know it can be a common problem. Tell her also that its not a permanent problem

Life Skills Children Can Learn

Children can learn that their parents respectfully and lovingly help them learn to deal with problems that are physical or developmental. Both parents and children can learn effective ways to interact with each other.

Treatment:

There are a number of management options for bedwetting. The following options apply when the bedwetting is not caused by a specifically identifiable medical condition such as a bladder abnormality or diabetes. Treatment is recommended when there is a specific medical condition such as bladder abnormalities, infection, or diabetes. It is also considered when bedwetting may harm the child's self-esteem or relationships with family/friends. Only a small percentage of bedwetting is caused by a specific medical condition, so most treatment is prompted by concern for the child's emotional welfare. Behavioral treatment of bedwetting overall tends to show increased self-esteem for children

Effective:

Simple behavioral methods are recommended as initial treatment.Enuresis alarm therapy and medications may be more effective but have potential side effects.

Motivational therapy in nocturnal enuresis mainly involves parent and child education. Guilt should be allayed by providing facts. Fluids should be restricted 2 hours prior to bed. The child should be encouraged to empty the bladder completely prior to going to bed. Positive reinforcement can be initiated by setting up a diary or chart to monitor progress and establishing a system to reward the child for each night that he or she is dry. The child should participate in morning cleanup as a natural, nonpunitive consequence of wetting. This method is particularly helpful in younger children (<8 years) and will achieve dryness in 15-20% of the patients.

Waiting: Almost all children will outgrow bedwetting. For this reason, urologists and pediatricians frequently recommend delaying treatment until the child is at least six or seven years old. Physicians may begin treatment earlier if they perceive the condition is damaging the child's self-esteem and/or relationships with family/friends.

Bedwetting alarms: Physicians also frequently suggest bedwetting alarms which sound a loud tone when they sense moisture. This can help condition the child to wake at the sensation of a full bladder. 

Medicines: Like DDAVP and tricyclic antedepressants.

Condition management:

Absorbent underwear: Absorbent underwear or diapers can reduce embarrassment for bedwetters and make cleanup easier for caregivers. These products are known as training pants or diapers when used for younger children, and as absorbent underwear or incontinence briefs when marketed for older children and adults. Some brands of diaper are marketed especially for people with bedwetting. A major benefit is the reduced stress on both the bedwetter and caregivers. Absorbent underwear can be especially beneficial for bedwetting children wishing to attend sleepovers or campouts, reducing emotional problems caused by social isolation and/or embarrassment in front of peers. Extended diaper usage may interfere with learning to stay dry at night, at least in adults with severe disabilities.

Waterproof mattress pads are used in some cases to ease clean-up of bedwetting incidents, however they only protect the mattress, and the sheets, bedding or sleeping partner may be soiled