BEDWETTING - Full extract 

Adam is eight years old and keeps very well. The last time I saw him was when he had tonsillitis at kindergarten. On this occasion he came into the surgery with his father.

When I asked how I could help, things went quiet. "Would you like to tell the doctor, or would you prefer me to?" asked his father. No response. After an awkward silence, his father said: "Adam has a problem with wetting his bed and he would like something done about it."

A full general examination, including blood pressure, proved entirely normal. A urine test was also clear. I explained that Adam was not unusual in having a bed-wetting problem, not that he wanted to talk about it much. However, he was keen to get on some treatment.

An appointment was made for Adam to be supplied with a bell and pad machine. Within six weeks, his problem had disappeared.

Bedwetting, or enuresis, can be very distressing. For some children, it can be a real source of embarrassment and may interfere not only with social activities but also with self-esteem.

It is very common. About one-third of children wet their bed at four years. This drops to one in eight at six years, one in 20 by 10 years and about one in 50 by 15 years. In almost every case, the bedwetting corrects itself as the child grows older.

It is best to regard bedwetting as a learning problem. When we sleep, the bladder gradually fills with urine. Normally stretch receptors in the bladder wall activate and relay a message to our brain that we need to get up to pass urine. When someone has a bedwetting problem, this process just doesn't happen. The bladder fills up a certain amount and then just empties without the message getting through. It probably has something to do with the nerves supplying the bladder taking longer to fully mature.

The condition is more common in boys and there is a family history in about two-thirds of cases. In some instances, bedwetting appears at times of stress such as starting school, shifting house or family disharmony.

If bedwetting has continued from infancy, the child is said to have primary enuresis. This is the most common type and is unlikely to be associated with problems like urinary tract infections.

A child who starts bedwetting after a period of being dry is said to have secondary enuresis. Although tests should be performed to rule out underlying health problems, things often turn out to be quite normal. Daytime wetting is another problem and always requires careful assessment to ensure there is no underlying cause, such as a urinary tract infection.

It is important to understand that bedwetting has nothing to do with laziness or bad behaviour. Fortunately, most people are now aware of this and appreciate that punishment of any sort is inappropriate. Disciplinary measures are likely to make matters much worse.

We have to make sure any treatment for bedwetting is safe and simple. There is no point in treating children before the age of six, because of the natural tendency for the condition to right itself.

The bell and pad machine is a most effective form of treatment. This is an electronic device consisting of a rubber pad placed under a thin sheet. When any urine is passed, an alarm rings. The child gets up to pass urine and then resets the alarm. It works well and is very safe. About 80 per cent of children are cured within a couple of months. However, a third or so may relapse and require a second course.

Motivational techniques like charts with stars and stickers can be tied in with the treatment to reinforce the learning process. The main approach is to praise or reinforce the good result, without taking too much notice of any wet beds along the way.

Other children who are still bedwetting and who have not been helped by a pad and bell alarm may be offered a special nasal spray called desmopressin. Because the spray interferes with the body's fluid balance it needs to be used under close medical supervision. A special authorisation for the medication is required.

Health Tip:
* When children wet their bed, it is important to be positive and reassuring. In nearly every case, the problem can be treated successfully.

Dr. Andrew Pattison: Common Consultations
North East Valley Division General Practice, Melbourne, Australia.   Disclaimer
  - Last modified: August 18, 2001