Bed-Wetting or Enuresis in Children

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Information on Bed-Wetting or Enuresis in Children

Bed-wetting is really not a disease, but a symptom.  It is considered here, because it is a problem in many families.  At age two, about 40 percent of children wet their beds at night.  By age four and one half, 12 percent are still bed-wetters, and by age eight , 7 percent.  A few children do not gain control of the bladder-emptying function until about age 12.


Doubtless several factors cause the problem of late bladder control.  Some bed-wetting children sleep very soundly part of the time, and this may interfere with the development of the control pattern by which the brain overrules the emptying reflex even during sleep.  In some cases the bladder's capacity does not increase in proportion to general body growth.


In an estimated 20 percent of cases, a hindrance to free flow of urine exists somewhere between the bladder and the outside.  This may not hinder the emptying of the child's bladder when he is awake, but it disturbs the functional balances enough to cause bed-wetting at night.  The hindrance may consist of simple folds in the membrane that lines the urethra.  It may consist of  a narrow place (stricture) along the course of the urethra or of an unusually small opening at the external end of the urethra.  Diabetes, when present, causes the person to drink more water and thus to have more urine to expel.  Emotional problems were formerly blamed for many cases of bed-wetting, but it is now believed that bed-wetting of itself is not proof that a child is emotionally distraught.


Do not punish a child who wets the bed.  He does not do this intentionally.  It is uncomfortable to him.  Be sympathetic and solicit his cooperation in overcoming the problem.  Establish a program to increase the bladder capacity.  By deliberately emptying the bladder less frequently during the daytime the bladder stretches to accommodate a larger volume of urine, and this stimulates its growth.  To start the program, a chart must be kept day by day, recording the time of day the child goes to the toilet and the volume of urine passed each time.  This requires use of a measuring glass.  After keeping the record for a few days, the child is then encouraged to hold his urine as long as possible after he has the urge to void.  Praise him each time he holds his urine a little longer and each time he voids a larger volume.


Do not restrict the water the child drinks during the day.  But it is well for him to drink very little water, if any, after his evening meal.  He should not be criticized when he still wets the bed occasionally.  However, the bed-wetting should become less frequent as the program proceeds.  Praise the child when he remains dry all night.  This program of increasing the bladder's capacity may need to last as long as six months.


If the above program does not give good results, take the child to a urologist, who will advise on whether simple surgery (such as dilating the urethra) may relieve the problem.  Urologists also use the drug imipramine (Tofranil) in the treatment of bed-wetting cases.


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