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A closer look at Enuresis

Enuresis is involuntary urination at an age when children are older and expected to stay dry.

Enuresis is more widespread than people think and it has been embarrassing children and some adults since at least the Egyptian times 3,000 years ago. For most families, enuresis refers to nighttime bedwetting.

As many as one in five children still wet the bed at least once a month at the age of 5 years, according to one report. Another source estimates that up to seven million children have nighttime enuresis. The condition decreases as children grow older and in most people it has disappeared by the teen years.

Most children outgrow their bedwetting. However, parents should consult their child's physician if the condition is causing concerns for themselves or the child after the age of 5 or 6. There are several ways the doctor can help, most importantly by ruling out other more serious health problems, such as diabetes or malfunction of the bladder or urinary tract. Doctors also can prescribe treatment plans or medications that curtail if not eliminate nighttime bedwetting.

Bedwetting is defined as "primary" if it has been going on since infancy. It is considered "secondary" if it crops up after six months of a child being dry. Another part of the definition tells whether the condition is nocturnal (nighttime bed wetting) or diurnal (daytime). For most children, enuresis happens at night. It is more prevalent in boys and it may be inherited from one or both parents.

The exact cause of enuresis isn't known, and many factors may contribute to it. Among these is a developmental delay in the central nervous system's influence over bladder control. Another possibility is that bed-wetters do not produce high levels of a hormone that recycles water from the urine back into the bloodstream. As a possible result, too much urine is formed, the bladder gets full, and the child doesn't get the neural message in time to prevent an accidental bedwetting. Another factor may be the deep sleep of children. They simply don't wake up enough to know that they should go to the bathroom.

Researchers have noticed that bedwetting and attention deficit hyperactivity disorder commonly go together. One report suggests that nearly half the children with ADHD also are enuretic. One possibility is that children with ADHD and a genetic tendency to bedwetting are less able to wake up enough to go to the bathroom in time. While deep sleep patterns may be involved, reports indicate that emotional and behavioral problems are not a cause of enuresis in normal child development. Enuresis that persists past the age of 8 to 10 years, however, may be associated with a lack of self-esteem or psychological problems. In this event, medical attention and counseling may be considered. For some, enuresis continues into adulthood and should be approached from a medical as well as psychological perspective.

Whatever the cause of enuresis, parents and caregivers have a special responsibility to avoid allowing the condition to scar a child's psyche. This could cause a lifetime deficit of self-confidence and self-esteem. Although difficult, patience and understanding are the desired response of parents to children who wet the bed. Enuresis has numerous effects on children, most of them adverse. It creates stress with the parents. Family relationships are clouded by the child's shame and guilt. Children who wet the bed often feel fear, worthlessness, anxiety, and even depression. They see themselves as different from others and avoid the possible embarrassment that might occur by staying overnight at another child's house. They may fear visits to relatives or staying in hotels where they may be found out. Overnight school field trips seem out of the question. All these psychological harms are compounded if unsympathetic parents scold, punish, or embarrass the child.

A positive approach by a parent or caregiver would be to seek a physician's examination to ensure there are no medical causes of the condition. After that, a physician may recommend a treatment plan from one or more options.

These include a battery-powered alarm system designed to wake the child at the first few drops of urine. The child must be motivated to make this work, and the device must be used for several months to see an improvement. The alarm is used until the child stays dry for at least two weeks, and some people advocate continued use to "over-learn" the habit of waking to go to the bathroom. This is done by encouraging the child to drink extra fluid to condition the bladder to being fuller than usual.

Physicians may prescribe several medications that suppress enuretic behavior. One of these has become popular in a nasal spray form that reduces the amount of urine created by the kidneys. Medications have side effects and should be used only under a doctor's direction and care.

Meanwhile, parents and caregivers can consider measures to help children. These include a daily routine of avoiding consumption of fluids or caffeine before bedtime, making sure the bathroom is accessible and well lit, getting the child up to go to the bathroom at a set time each night, taking the child out of diapers or training pants, requiring the child to take soiled sheets to the laundry room (not as punishment, but as a routine activity), and protecting the child's self-esteem.

Persons interested in additional information about enuresis may contact the National Enuresis Society at 1-800-NES-8080.

Enuresis is an embarrassing condition for children, especially as they grow older. To avoid stigmatizing children, the profiles of children available for adoption through the Texas Adoption Resource Exchange (TARE) merely mention the fact that a child has enuresis, without further elaboration. The same courtesy is extended to children with other undesired conditions, such as encopresis (uncontrolled bowel movements).

If you are a Texas resident and are not approved as a foster or adoptive family, please fill out our Adoption and Foster Care Interest form in the Get Started section.

If you have questions or want to inquire about a specific child or sibling group, contact the Texas Adoption Resource Exchange (TARE) or call 1-800-233-3405.

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