The child is unable to control urine voiding, usually during nightime. A neonate is a natural enuretic and only by the age of 2-3 years is the child able to have some degree of mastery over his voiding of urine. As the child masters it, he gets up at night whenever he has the urge to pass urine and tells his parents. Such a child, by and large, is day and night-time dry and only occasionally, he may pass urine in his pants e.g. when he is too busy playing or when he is in a deep sleep. Such rare occasions are normal and the child should not be made conscious of it or scolded or made to feel guilty.
For children who are not able to achieve this control, doctors prefer to wait till the age of 5 years before considering it as a problem. So if your child is bed-wetting say at the age of 3 Vi years, it may just be that he requires some more time to be able to control it. Don’t worry about it much as most likely the child will outgrow it with time. Above 5 years, for a bed wetting child, the doctor may prescribe some simple tests like urine examination to rule out a problem with the urinary tract and if none is found (as is usually the case); the child is said to be suffering from “psychogenic” bed-wetting.
This is the commonest type of bed-wetting and is usually due to stress felt by the child during the time that he was being toilet trained. For example, if a child of 3 years is unable to control himself and wets his pants regularly, the parents may scold or beat him, humiliate him and convey to him “you are good for nothing “type of attitude. This type of toilet training where there is conflict and tension between the child and the parents (called “coercive toilet training”) undermines the confidence of the child, phis he secretly resents the whole process.
This adverse psychological effect on the child leads to his being a bed wetter. For such a problem, it is important for the parents to realise that the child is not wetting deliberately. He wants to cooperate and would give anything to overcome the problem. But he has little control over the unconscious feelings that produce the wetting in his sleep. What he needs is more confidence in his ability to control the wetting and this can only be gradually built up with patience and help from the parents.
All negative remarks from the parents should completely stop. Don’t humiliate or demean the child. Instead the general attitude should be one of encouragement. They should explain to the child that quite a few children have this problem but that practically all of them overcome it with time, as it is transient in nature. They can express confidence in their child that he, too, will also surely overcome it. The child should be praised and encouraged if he doesn’t bedwet one night or if the frequency of bedwetting is reduced.
A chart can be maintained on a “to be reviewed weekly” basis and improvement found in one week over the preceding week should be lauded. The child can also be rewarded by giving him some coveted article like toy etc. on showing improvement. Intermittent failures or worsening should be ignored. Making the child drink less fluid after evenings may be of some help. Waking the child up every night from deep sleep and making him urinate is of doubtful benefit.
Drug therapy for this condition is not satisfactory. The medicines may be able to control bedwetting, but obviously they cannot be given for an indefinite period and so when they are stopped, the child may again start bed wetting. Some conditioning alarms are available those ring a bell when the bed is wet and are effective in some cases. Then there is another way of treatment called “bladder training.”
It is found that many enuretic children have a low bladder capacity. So during the daytime the child is encouraged to postpone urination (when he feels the urge) as long as possible. Parents can help by diverting the attention of the child during this voluntary “urine retention.” Usually it is seen that within 6 months of seeking medical opinion, the child is cured irrespective of the type of therapy.
What has been discussed so far is about a child who never was able to achieve control (called “primary enuresis”). What about those children who had achieved control satisfactorily and now again have started bed-wetting (called “regressive or secondary bed-wetting”)? In these cases, the usual cause is some change in the lifestyle or routine of the child or some emotional trauma to the child. Examples are shifting to a new house, birth of a baby in the family, some tragedy in the family, when the child starts his schooling etc. Secondary bed wetters are easier to treat and the problem is usually transient.