Bedwetting (cont.)
What is the basic problem in primary bedwetting?
The fundamental problem faced by children with primary bedwetting rests in
the inability while asleep to recognize neurologic messages sent by
the full bladder to the sleep arousal centers of the brain. In
addition, bladder capacity is often smaller in bedwetting children than in
their peers.
Is primary bedwetting due to emotional problems?
Parents sometimes believe that their child's primary bedwetting is
emotional. No medical or scientific literature exists to
support this impression.
How is primary bedwetting treated?
The "cure" for primary bedwetting is "tincture (or passage) of time."
However, since many parents and children are appropriately frustrated
with bedwetting as it starts to interfere with self-esteem or social
events (for example, sleepovers), a step-by-step approach can be anticipated
to have a successful outcome in over 75% of such patients.
You should always discuss treatment options with your child's physician, since it is important to differentiate between primary and secondary enuresis prior to starting treatments.
It is also important to remember that different children develop differently and that primary enuresis can be a normal developmental stage. Toilet training a child requires patience. Most children are fully toilet trained by 3-4 years of age. Many will not stay dry overnight, even though they can during the day. Reassurance and encouragement often will work in time, but for some children, there are steps that can be taken to address the issues.
Some common recommended management and treatment options include the following:
1. Encourage voiding prior to bedtime, and restrict fluid intake before bed.
2. Cover the mattress with plastic.
3. Bedwetting alarms: This is generally reserved for older school-age children. There are commercial alarms that are available at most pharmacies. When the device senses urine, it alarms and wakes up the child so he/she can use the toilet. The cure rate is variable.
4. Bladder-stretching exercises are aimed at increasing the bladder volume and increasing the periods between daytime urinations.
5. Medications such as DDAVP (desmopressin acetate) and Tofrinil (imipramine) and have been shown to be very effective and are used to temporarily treat the nighttime urination but do not "cure" the enuresis. Many pediatricians will prescribe one of these medications especially if the child is engaged in behavioral conditioning concurrently. Medications are very helpful when a child is not sleeping at home (camp or sleepovers), since the associated trauma of bedwetting in those settings is unavoidable.
Next: How common is secondary bedwetting? »
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