What is Enuresis?
Enuresis is one of the most frequent and one of the most annoying disorders of childhood. A child is expected to become dry during the night between the ages of 2-4 years old. At age 4 - 25% of children are wet by night. At age 6 - 15%, at age 12 – 5% and at age 18 and over - 2% still have Nocturnal Enuresis.
Enuresis is more common among males. Two thirds are males. During adolescence the proportions are equal . At older ages (17 and up) over 70% are females.
Enuresis has a clear hereditary (familial) factor. Over 70% of enuretics have a family history of enuresis (parent or sibling).
Contrary to common thinking, the majority of enuretics have neither anatomic (medical) nor psychological problems. A medical problem such as urinary tract infections, kidneys problems, neurological problems etc., was found in only 2%. When the child is dry during the day and wet only while he is asleep, the chance for a medical problem is very low. We use the same urinary system by day and by night. The difference is in the continence systems in the brain: conscious system during the day and subconscious during sleep.
In 20-25% of cases a psychological factor was found (marital problems, battered children, conflict between the child and the parents, sex abuse, fears, social problems, adjustment problems and more).
Most enuretics (75%-80%) are classified as continence learning problems. The basic fault is a poor arousal response to bodily or environmental stimuli due to unusually deep sleep. These are normal and healthy children. During sleep, the reflex system in the brain does not identify the signal from the pressured bladder and instead of contracting the bladder sphincter muscles, the child does the opposite act, relaxes the muscles and causes urine emission.
Parents of these children report that their child is an unusually heavy sleeper and he does not feel when he wets in bed. They describe attempts to take the child to the toilet while he is asleep as dragging a sack of potatoes. The child does not feel anything, he is in complete disorientation. In the morning he has no recollection of the event.
Many parents, due to lack of knowledge and understanding, make mistakes such as punishing or humiliating the wet child or utterly disregarding the existence of the problem. Parents should bear in mind that the principal sufferer is the child himself. The bedwetting act is subconscious, the child does not do it on purpose. When the parent reflects disappointment or punishes the child, he is only making the situation worse.
Another common mistake is to wake the child while he is asleep and taking him to the toilet. The parent takes the responsibility from the child and prevents the learning system to develop.
Fluid restriction before sleep is also a common mistake. The bladder is getting used to functioning with a low volume of urine.
It is essential that the treatment be done by a professional who specializes in enuresis.
The following are the most common methods for the treatment of enuresis.
Drug efficiency is limited. We might see some progress during the drug usage but should expect a relapse when the patient stops using the drug. The drugs sometimes have side effects.
The success rate with Tofranil (Imipramine) is about 30% with an expected relapse rate of 50%.
The success rate with the anti diuretic hormone (A.D.H) D.D.A.V.P is about 80%. The relapse rate is 60%-90%.
Behavioral treatment with an enuresis alarm is considered as the most effective treatment. The child is going through a learning process which enables him to identify the signal from the bladder during sleep (conditioning of the reflex system).
We can expect an up to 50% success rate. The rest will need additional learning techniques in order to gain conditioning.
Psychological treatment can be effective only with cases where the causes for enuresis are psychological. The enuresis is a symptom of other problems in the child's life.
Other treatment methods
The following treatment methods are considered as marginal and ineffective for the treatment of enuresis: Reflexology, Homeopathy, Acupuncture, Hypnosis, Bach flowers, special diets and other alternative methods.