Enuresis – Better Known As Bedwetting

Enuresis is better known as bedwetting.  A diagnosis can only be made at the age of 5 years when a child should be toilet trained and is chronologically of the age where the child is able to control the bladder.  Provided by this age no diagnosis was made where any organic causes of bladder dysfunction was ruled out i.e. urinary tract infections, obstructions or anatomical conditions – i.e. kidneys etc.  It can occur at night (nocturnal) and or during the day (diurnal).

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Generic factors could also play a role where first degree relatives like the father had Enuresis.  These children’s chances of becoming Enuretic are 7 times greater than other children.

Most children are not even aware of wetting the bed until the bed is wet.  Bedwetting does not appear to be related to a specific sleep or time of the night pattern.  Bedwetting appears randomly and sleep is normal in most cases.  Children with Enuresis sleep more soundly.

Psychosocial stressors appear to precipitate in young children.

1. Lengthy stays in hospitals between the age of two and four years.
2. The birth of a sibling.
3. Start of school.
4. Break up of families – Divorce or death of somebody in the family – a parent or sibling.
5. Moving to a new home or school uprooting the child.
6. Sexual abuse.
7. Physical or emotional abuse.
8. Bullying.
9. Being scared i.e. scary movies or trauma of any kind.

A child must be at least five years of age before a psychological diagnosis can be made.  Bedwetting must occur at least twice weekly for at least three months or must cause distress and impairment of function to meet diagnostic criteria and only if bedwetting is not caused by a medical condition.  These medical conditions can vary from child to child and it is important that your doctor investigates all possible causes.

When your child wets the bed once or twice this is not Enuresis, it is an accident and was probably caused by drinking too much fluids or not going to the toilet before bedtime.  Or watching a scary movie.

When your child at the age of five years wets the bed regularly take the child to your GP and have the child medically investigated.  If no known medical cause is found let your doctor refer your child to a Psychologist or Psychiatrist.  Your doctor will know best whom to send your child too.

Treat your child with Enuresis as follows:

1. Never scare your child or tell your child it is his/her fault.
2. Make your child feel safe and secure.
3. Keep this between yourself, your child and the doctor if your child’s friends know they can tease your child and this can make your child feel more insecure.
4. Investigate medical or psychological causes as listed above.
5. Always give medication as prescribed.
6. Don’t let your child drink any fluids after 6 pm. The more fluids your child drinks after this time the fuller the bladder and your child might not be able to empty the bladder completely before bedtime.
7. Stick to a routine as this helps to make the child feel more secure i.e. bedtime always at 8 pm.
8. Make sure your child goes to the bathroom immediately before going to bed and make sure your child empties the bladder.  Children will say they went to the bathroom while going to the bathroom got sidetracked or they will tell you that they don’t need to go.  Also make sure that your child do not go and drink water in the bathroom or elsewhere as children tend to do this.
9. Wake your child at least twice a night and take your child to the bathroom i.e. 11 pm and then again at 3 pm.
10. If bedwetting still continues make a chart and note down the times you find the bed wet.  Work out a routine to wake up your child according to this chart and times.
11. Make a star chart for every night of the week or month and reward your child with a star every time the bed is dry.  After a certain amount of nights a gold star can be given as reward.
12. Reward your child for any period of time the bed is dry i.e. dry for a week reward with a chocolate.  Don’t take the rewards to the extreme.  A chocolate, movie or small toy will suffice.
13. Always praise your child for his or her dry bed.
14.  Be patient with your child and do not discipline your child for wetting the bed or let your child wash his/her own bedclothes and linen.  This will make your child feel more insecure and unhappy.
15.  Even when potty training take your time and do not get angry if your child does not immediately do what you want your child to do.
16.  Keep using nappies at night until your child is completely potty trained and dry at night.  Pull up nappies work well for day time.  Undies during the day time will give them more self esteem and will let your child feel more grown.

Poor self image, significant emotional and social difficulties, decreased self esteem, social embarrassment and restriction and interfamilial conflict can cause Enuresis as well as disorders like ADHD and attachment disorders is a common sign of Anxiety disorders.

Love and accept your child.  Make your child feel safe and support your child as your child will grow out of this even it takes a very long time!

SYNOPSIS OF CLINICAL PSYCHIATRY BY HADDOCK & HADDOCK 10^th EDITION

Written by Jennie Nel

jenniec@live.co.za