Enuresis
Enuresis is the name given to nocturnal bed-wetting. The child achieves continence when they learn to override the bladder reflex which occurs when the bladder becomes distended. Most children achieve this by the age of four, but up to 15 per cent may take longer, and some still have nocturnal incontinence into their teens. This is a genetic problem, and there is usually a family history. Underlying causes such as a urinary tract infection or renal disease need to be excluded. Since this is a problem beyond the child's control it is important that punitive measures be avoided; making the child guilty and anxious will not help. Behavioural approaches such as the use of star charts, where the child is rewarded by a star for each dry night might be effective, as may alarms which wake the child when they start to pass urine. There is an effective treatment available using synthetic anti diuretic hormone, either as a nasal spray or as tablets. This is the hormone secreted by the pituitary gland which acts in the kidney to re absorb water. It is useful as a short-term measure to allow, for example, the child to stay overnight with friends or go on school trips without embarrassment. It may be used to try to establish continence over a short period of time. Eventually, as the child matures, continence will be established.
With a child who becomes incontinent after having been dry it is important to exclude a urine infection or underlying psychological problem such as emotional stress. Infection should be treated, and love and emotional support provided to help their anxiety.
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