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Introduction
Enuresis
is the common occurrence of voidings during sleep after the
age of 6. One boy out of 20 continues to wet the bed after 6 years
of age, and one girl out of 20 after the age of 5. It is a frequent
problem, often distressing for the family. Sometimes, the
enuretic child is viewed as sick, rebellious or in need of
psychiatric treatment. Actually, enuresis is basically an isolated
developmental delay. In some families, children normally become dry at night at about
age 12. A genetic or organic component may be present, justifying a
medical approach. On the other hand, psychotherapeutic
interventions are seldom justifiable. Which does not mean that
psychological mistakes are without consequences. It is sometimes said
that the attainment of night dryness can be delayed
by the family, but never hastened. In general for simple
enuresis, psychotherapy is ineffective, if not
counterproductive.
Proposed approach
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Perform a urinalysis to rule out infection, at least with an urine paper strip test.
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Measure the bladder
functional capacity : this is the urine volume produced when
the child feels an urge to void. About 5-10 measurements
are usually enough. They allow an accurate estimate of the
bladder's functional size, but also detect an unstable bladder
if values vary markedly. Normally the bladder capacity is about 85 ml around two years of age. At 4 years and 1/2 it should reach 200 ml, allowing night dryness. At 7 years and ½ it is about 225 ml, having increased less.
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In
doubt, an ultrasound study of the urinary tract is obtained to observe
bladder volume, shape, wall thickness, and rule out stones or
localized dilations.
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Voiding
exercises during the day : train the pelvic floor muscles by
stopping the urinary stream approximately half-way and then
resume to empty the bladder completely. This is important, a bladder
residue can cause infection.
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Always empty the bladder when leaving the house.
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"Paradoxical
injunction" : pretend to pay no attention or grant no importance to a wet
bed. Since psychological factors often play a decisive role (which does not imply
any psychological anomaly or disease) the least parents or
guardians worry about the child's problem the better. A glass of water
on the night table is a useful symbolic tool, providing
evidence of adult tolerance or perhaps even better, lack
or concern. This method is effective in reducing night
"accidents" in children's homes. On the other hand, a child who feels
under pressure and wakes up wet, inevitably
feels frustrated, with an impression of failure or guilt, of
disappointing adults and the feeling of not being up to
their expectations. More or less consciously he or she will
fear the following night. And we know that even slight, diffuse anxiety
increases urine pressure within the bladder and the risk of sleep
incontinence during sleep.
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Night
self-reliance : if napkins have been abandoned, the child
must be in charge of changing wet linen and clothing. .
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Active measures :
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