Enuresis
Enuresis means incontinence of urine. (it comes from the Greek for urination). Children achieve continence when they learn to override the reflex contraction of the bladder which happens when it has been distended by a certain amount of urine. Under normal circumstances most children become dry by day at around about two years of age, and by night between two and a half and three, though there are wide variations. Children who have been dry and then become incontinent during the day (called secondary enuresis) may have developed a urinary tract infection which should be excluded.
A small percentage of children do not achieve nighttime dryness until they are much older (some not until they are in their teens). There is often a family history of delayed nocturnal continence. The urine should be examined to exclude an infection, or other disorder affecting the renal tract, and in the absence of abnormality the management of the problem should be aimed at modifying the behavioural response to a full bladder. The use of star charts (where the child is given a star for each dry night) is sometimes helpful, as are alarms which wake the child (and everybody else) when they start to pass urine. Continence can often be achieved by using a nasal spray or tablets containing a synthetic version of ADH - anti diuretic hormone - which may be useful to allow a child to spend a night sleeping in a friend's house without embarrassment. All children should be encouraged to understand that this condition is not of their making, and will eventually be conquered.
|
