If this disorder affects you or a loved one, you will be comforted to know that you are not alone and that it can be treated

“IT RUINED my adolescence!” ‘Endless washing of soiled bedding and pajamas!’ A “stigma” and an “embarrassment!”

These are the heartrending cries from parents and children alike who are victims of the distressing problem of bed-wetting. It is a perplexing affliction that, for those involved, is not an easy one to discuss openly.
Yet, bed-wetting is widespread. It affects an estimated five million children in the United States alone, so it is a subject of much attention and investigation. What causes it?
“Nocturnal enuresis” is the medical label tagged to bed-wetting. It means an involuntary loss of urine occurring at night at an age when, normally, nighttime control of urination would be expected. At what age do most children develop this control? There is some cultural variation, but 1 child in 5 wets more than once a week at age 3, 1 in 10 at age 5, but only 1 in 35 at age 14.
These figures illustrate that the problem of bed-wetting is eventually mastered over a period of time. In fact, one researcher found that 75 percent of those in one study were cured over a five-year period. Boys are affected more frequently than girls, and it seems the disorder runs in the family, with a parent, a brother, or a sister also having been affected.

Possible Causes
Sometimes, though rarely, enuresis is caused by a disease, such as urinary infection, diabetes, food allergies, or a physical abnormality of the bladder, kidneys, or nervous system. A disease is likely the cause if daytime control is also lacking. When bed-wetting persists past age five or six, a medical evaluation may be called for to see if a disease exists if daytime wetting also occurs and if bed-wetting recurs after a period of dryness.

While in the past some viewed enuresis as the manifestation of a neurotic disorder, medical experts are now in agreement that it is not intentional and is not a symptom of psychological disturbance. The cause of bed-wetting is otherwise unknown, although many theories have been proposed, such as a small bladder capacity, slow maturation of bladder control, familial tendency, and disorders of sleep patterns. More than one of these conditions may exist in a particular child.
If a child has had nighttime control of urination for six months or more and then resumes bed-wetting, a physical disease or an emotional upset is more likely to be the cause. Such things as the arrival of a new baby, a new stepparent, a move to a new home, or other family disruption can initiate bed-wetting again. More frequently, however, emotional disturbances such as guilt feelings, inadequacy, loss of self-esteem, and anxiety arise because of the bed-wetting.

How to Deal With It
“The worst thing you can do is threaten them. It gets worse if you threaten; it doesn’t get better,” says Lorraine, who was a bed wetter until age 19. “There is no point in getting angry with the child,” explains a mother whose eight-year-old son, Julien, is affected.
Punishment, shaming, and degradation are ineffective treatments because the child is unable to control the bed-wetting. These reactions serve only to increase guilt and embarrassment but have no beneficial effect on the problem. Parents should, rather, attempt to reduce the emotional impact on the child. “Try to minimize the embarrassment and be understanding,” cautions Lorraine. “Try not to attach any stigma to it—the child already feels guilty.”

Many therapeutic approaches exist, but none are predictably of value in a given child. Therefore, the family may be faced with trying different approaches in sequence. The age of the child involved may also determine the treatment used. Since enuresis tends to stop spontaneously, some parents prefer to wait. In the absence of any physical problem or emotional disturbance in the child, it may be best to wait. The fact is, the child may be distressed by testing and treatment procedures.
Bed-wetting does, though, cause increased work, emotional stress, and embarrassment for all concerned. Activities such as overnight visits to friends and relatives may be curtailed. “You’re having so many social problems,” Lorraine noted, “that it leaves its mark on you.”
Putting off treatment indefinitely, therefore, is unwise. Lorraine urges: “Don’t let it go. In the meantime, you can be traumatized by it. You set a pattern.” “It becomes a habit,” says Julien’s mother.

What Can Help
Before beginning on a course of treatment, care should be taken to ensure that the treatment does not cause more harm than the initial problem. Some authorities feel treatment should not be started until the child is six to eight years of age. Bed-wetting is not usually distressing to the child prior to this age. Besides, older children show a better response to treatment.

Some strategies to help the parent cope include the use of a plastic mattress cover or absorbent pads to protect the mattress and having the child help with the cleanup. Wearing extra-thick underwear in addition to pajamas will prevent much of the urine from getting through to bed sheets. Older children may set an alarm so that they will get up and go to the bathroom before bed-wetting occurs. Counseling and reassurance alone may result in improvement. Helping the child understand the problem and involving him in the treatment process increase the likelihood of success.

Simple measures such as restriction of fluids after supper (especially of caffeine-containing beverages, including colas), making sure the child uses the toilet at bedtime, and waking him during the night to urinate, as well as praise for dry nights, may reduce or eliminate bed-wetting. If the child keeps a record of dry nights, this in itself can be an encouragement and may result in improvement. Also, training the child to hold progressively larger volumes of urine during the day has helped.

A more elaborate approach is the use of a urine alarm system. A few drops of urine on a urine-sensitive pad placed under the child at night will activate the alarm to awaken the child. Success in eliminating enuresis by this means is reported to be as high as 60 to 90 percent, though relapses are reported in 10 to 45 percent of those treated. Retreatment may result in cure.
A combination of these measures, termed “Dry Bed Training,” has resulted in cessation of bed-wetting in almost all children treated. Unfortunately, 20 to 30 percent of children suffer relapse once the treatment is stopped, but a repeat treatment of these children may result in permanent success.

A drug called imipramine has been shown to reduce bed-wetting, but side effects are common and the relapse rate is high. Accidental overdose and death caused by imipramine have been reported, so caution is advised when using this approach. Continued medical supervision is recommended while this drug is being used.

Some have used other forms of treatment. “I’d suggest going to a chiropractor. I can see the improvement in my son in just a matter of two and a half months,” claims the mother of Julien. Studies of acupuncture treatment for enuresis show a 40-percent success rate. And herbalists outline various plants and herbs that purportedly alleviate bed-wetting. In some areas, there are clinics that specialize in the problem.
For most, the problem just disappears, or it is resolved after treatment. And as Lorraine observes: “People are immensely relieved to find out there is someone else who has experienced the same thing.” This reassurance coupled with some of the available treatments may be the key to helping your child overcome the problem of bed-wetting.—Contributed by a medical doctor.

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