Bedwetting or nocturnal enuresis as it is known by people in white coats that had a bit of Latin in their first year in Med school, is a problem that doctors deal with on a regular basis in their practices.
It's a problem as old as man - well, actually as old as man's first-born son, but it still seems that parents are in the dark about it. This article discusses primary nocturnal enuresis (NE), i.e. bedwetting in a child that has never been dry for more than six months.
Secondary NE, in which previous bedtime control is lost, is usually due to a stressful event or condition, but the chances of it being due to an organic condition like bladder infection or diabetes is higher than in the case of primary NE.
NE is defined as unwanted urination at night by children past the age when voluntary control of urination could be expected (six years).
It is present in 30% of normal children at age four years, 10% at age six, 3% at age 12 and 1% at age 18.
NE is more common in boys and tends to run in families. If both parents suffered from NE, the child has a 70% chance of being a bedwetter and a 44% chance if only one parent suffered from NE.
The cause of NE isn't fully understood and an underlying organic cause like bladder infection is diagnosed in only one to two percent of cases. Most children will "outgrow" NE at a rate of 15% per year if no treatment is given.
In spite of the fact that it will go away by itself, it is still very important to try and stop the bedwetting as fast as possible. NE usually occurs at the critical stage of a child's life when he or she is establishing relationships with peers and siblings. These relationships are critical for social development and will strongly affect a child's self-image. If handled incorrectly, NE can lead to poor scholastic performance and antisocial behaviour.
The golden rules of NE
- Parents have to remember that NE is a treatable medical problem just like the flu. When treating the flu, we treat the symptoms and give the body a chance to take care of the rest. It works the same with NE. The child should also be made aware of this and the fact that there are many other children suffering from the same problem.
- Never punish or scold the child when he or she wets the bed. The child has no control over the situation and scolding will increase his or her anxiety and worsen the problem.
- Involve the child in the treatment and let him or her take responsibility for it. Let them help remake the bed and put on dry clothes themselves.
- You can ignore the bedwetting, but never ignore the child.
- Don't keep the child from participating in normal overnight activities like sleepovers, camps and family vacations. There are ways to protect your child from embarrassment without preventing them participating in these normal activities. You can have them take an extra set of pyjamas and their own sleeping bag. They will feel safe in the knowledge that if they have an "accident" no-one will know of it as there will be no wet bedding as evidence. This alone will reduce the chance of having an "accident" substantially.
- Be patient! It can take some time to get better and relapses are common.
- Medical treatment is available, but it isn't the only option. The best results are achieved by a combination of motivational counselling and medicine.
(Dr Bram van Niekerk, general practitioner, updated December 2009)