Enuresis Essay, Research Paper

Enuresis

Enuresis is the medical term used to describe the involuntary discharge of urine

beyond the age when a child is old enough to be able to control urination (usually

considered to be six years of age for nighttime control), or more commonly, bedwetting.

There are several types of enuresis: diurnal enuresis is wetting that occurs during waking

hours, primary nocturnal enuresis is a lack of the achievement of total bladder control

during sleep, and secondary nocturnal enuresis is loss of bladder control that happens

after a child (or adult) has been dry a night for a long period of time (usually three to six

months). The facts, causes, and treatments of this disorder can help bring a greater

awareness and understanding of enuresis.

Nocturnal enuresis is a common problem. It is estimated that there are five to

seven million children in the United States who have NE. Many children have no lasting

problems from bed-wetting, however, some children who wet the bed can develop

psychological problems, including low self-esteem. This disorder also affects family

members through anger and frustration because of the condition.

One important reminder to parents with children who suffer from this condition is

that bed-wetting should not be thought of as a behavioral problem. There is no medical

proof to show that children wet the bed to spite their parents. Also, most children will

outgrow bed-wetting eventually. As parents, the best way to help your child is to be

understanding and remember that punishing or making fun of a child who wets the bed

can only make the situation worse.

Though as of yet a cause is unknown, some doctors believe that children who wet

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the bed might have small bladders or be such deep sleepers that the urge to urinate does

not wake them up. Of course, some research has proven that some children with NE

have normal-size bladders and have normal sleep patterns. What is known is that bed-

wetting is not a mental problem, a learning problem, or a behavioral problem. Though if

a child is punished in any way from the bed-wetting, psychological problems can arise.

Recent medical research, however, has found that many children with NE may have a

deficiency during sleep of an important hormone known as antidiuretic hormone (ADH).

ADH helps to concentrate urine during sleep hours–meaning that the urine contains less

water and is therefore of decreased volume. This decreased volume usually means that

their bladders do not overfill while they are asleep unless the child has had an excessive

quantity of fluids before bed. Testing has shown that many of these children do not show

the usual increase in ADH during sleep. Children with enuresis, therefore, often produce

more urine during hours of sleep that their bladders can hold. If they do not wake up, the

bladder releases the urine and the child wets the bed.

There are many successful treatments for bed-wetting. Some doctors recommend

bladder control exercises to help stretch and condition your child’s bladder and help him

or her to become more aware of bladder control as a part of learning to stay dry. These

exercises include learning to resist the immediate urge to urinate, in order to increase the

bladder size, and stopping urine flow midstream to strengthen bladder muscles.

Changing the child’s eating and drinking habits throughout the day and at bedtime may

also be recommended.

“Night-lifting” is a procedure that involves waking the child periodically

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throughout the night, walking the child to the bathroom to urinate, and then returning the

child to bed. The desired effect from this procedure is that the child will learn to awaken

and urinate many times during the night.

Moisture alarms is a treatment that requires a supportive and helpful family and

may take many weeks or even several months to work. Moisture alarms have good long-

term success and fewer relapses that medications. Alarms usually consist of a clip-on

sensor probe that attaches to the outside of bed-clothing. An alarm is set off when the

child begins to wet the bed. This alarm should wake the child, who will then go to the

bathroom to finish the urination before going back to sleep. If the child does not wake

up, the parent should help them to the bathroom

Hypnosis is another approach to the treatment of bed-wetting that is being used

successfully by doctors. Hypnosis is less expensive, less time-consuming, and less

dangerous than most approaches, because it has virtually no side effects. Because

hypnosis can give the child the power to treat themselves, this form of therapy can also

help build the child’s self-confidence and self-esteem as well as help with the bed-

wetting.

Some medications have also been used for this disorder. Antidepressants, for

example, have been used to suppress the urge, but not on a long-term basis. Imipramine

has been successful for approximately 30% of children. However, antidepressants are

powerful drugs and some can have serious side effects, especially in children.

Desmopressin acetate is a man-made form of antidiuretic hormone that works by

substituting for the natural hormone. It helps the child’s body make less urine, and thus

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lessens the risk that the child’s bladder will overflow during sleep. It is usually given in a

nasal spray form. Few side effects have been reported but some that have been noted are

headaches, runny nose, pain in the nostrils, and nasal stuffiness. It can also work quickly,

some after even the first dosage, but it is recommended for use for three months. It is in

some cases not a long-term substitute but restarting the dosage can be prescribed by a

doctor.

Enuresis is a very serious disorder for young children. It is sometimes seen as the

result of too much to drink before bedtime or the result of bad dreams, but is not.

Enuresis is a medical problem that, if not properly diagnosed and treated, can have

adverse consequences. These include loss of self-esteem for the child and psychological

distress for the child and the family. The National Kidney Foundation maintains a

physician referral service of physicians nationwide who have indicated an interest in

caring for patients with bed-wetting. This referral service can be reached at 1-800-622-

9010. Also, the National Enuresis Society can be reached via mail at 7777 Forest Lane

Suite C-737, Dallas, TX 75230-2518. Their foundation is dedicated to building greater

understanding of enuresis and can help with any problem relating to child enuresis.