|Posted by [email protected] on August 7, 2017 at 8:35 PM|
THE most encouraging thing to be said about persistent bedwetting among children is that, no matter what is done about it, 97 to 98 percent eventually outgrow it. This means, of course, that 2 to 3 percent reach adulthood without having achieved nighttime bladder control.
For the child who continues to wet alarm for bedwetting his bed into the elementary school years and beyond, it usually means considerable anxiety, embarrassment, loss of self‐esteem and restrictions on sleeping away from home. And for the parents, bed‐wetting is often a bothersome, frustrating and anger‐provoking problem that can result in a psychologically damaging battle with the child.
For these and other reasons, it pays to understand the various causes of bed‐wetting and to know how to handle a child who wets the bed and when to seek professional help.
A parent who looks into the matter is likely to find the field riddled with conflicting theories and approaches to treatment, complicated by persistent myths and misunderstandings on the part of laymen and doctors alike. There are, however, some generally accepted facts and opinions.
¶A child should not be expected to be dry at night until past the age of five, even though by this age between 75 and 90 percent do not wet their beds except on rare occasions. Children mature at different rates and, just as all children don't learn to read by the same age, all children cannot learn nighttime bladder control by the age of 3 or 4 .
“If a child is otherwise healthy and has never had a long stretch with a dry bed, don't worry about bed‐wetting until age five and a half,” advises Dr. Karen Olness, pediatrician at Minneapolis Children's Hospital.
¶Bed‐wetting occurs among children in all economic levels and degrees of intelligence. It is, however, more common among children from economically deprived homes, those with unstable home environments, and the mentally retarded. For unknown reasons, it's also more frequent among boys than girls.
¶If at any age a child is made to feel guilty about bed‐wetting, it's likely to perpetuate the problem rather than eliminate it. Children who go to bed anxious for any reason are more likely to wet the bed. In fact, even an anxietyprovoking television program or movie seen before bedtime can precipitate an episode of bed‐wetting.
¶A child who has been dry at night for several months or years may revert to bed‐wetting following an upsetting emotional experience, such as separa- tion from parents, death of a parent, divorce, or birth of a new sibling. This is usually only a temporary problem, unless it is compounded by adverse parental reactions, such as punishment, ridicule and anger. Sometimes, however, the child may need brief psychological help to cope better with the emotional stress.
¶If a child past the age of three and half or four continues to wet his pants both day and night, there is likely to be a physical cause that requires the attention of a physician, and possibly referral to a urologist. Physical problems also are sometimes the cause of persistent bed‐wetting in a child who is dry by day.
Before any treatment for bed-wetting is begun, a doctor's examination should rule out the probability of physical cause, which is a factor in less than 10 percent of cases. The examination should include a careful medical history, urinanalysis and urine culture, blood test, and simple neurological exam.
If any of these tests suggest an organic problem, X‐ray studies of the bladder, urethra and kidneys should be done. Such studies are necessary only in rare cases. Most of the physical disorders that cause bed‐wetting are correctable through surgery, drug or other therapy.
The doctor should also explore psychological factors and family situations that may be perpetuating bedwetting. Contrary to once widely held beliefs, bed‐wetting is rarely a sign that the child has deep‐seated psychological problems. More commonly, emotional disorders are the result, not the cause, of bed‐wetting.
However, if the parent has made toilet training a contest of wills, or if such training was instituted before the, child was mature enough to control his or her bladder night and day, the child may resist training and use bed‐wetting as weapon to “get back at Mommy.” After school age, however, the child should have enough reason to want to be dry to make a parent‐child battle the unlikely cause of persistent bed-wetting.
Sometimes, Dr. Olness of Minneapolis points out, the parents inadvertently reinforce bed‐wetting by “rewarding” the child, such as by having him come into their bed whenever he wets his own.
When it comes to treating bed-wetting for which no physical cause is apparent, controversy abounds. Some advocate only those methods that teach the child to control his own bladder and give him responsibility for his success. Others say that the problem is potentially so devastating, one should use any method that works. Among the more popular treatment approaches are the following:
Drug therapy. This should be reserved for children past the age of 6. Imipramine, a tranquilizer (marketed’ as Tofranil, among other brand names), is most commonly used, starting with a low dose at bedtime and working up to at most a dose of 50 milligrams (or 75 milligrams in a child past 12) if necessary. It takes a week to 10 days to see results, and treatment is usually continued for three to six months, with correction of the problem in more than three‐quarters of the cases. The trouble is, once the drug is stopped, a large percentage of children return to bed‐wetting. The drug may also produce such side effects as nightmares, depression and marked personality change, forcing its discontinuation.
Alarms. There are a variety of socalled conditioning devices that are placed in the bed or attached to the child and that ring an alarni as soon as the child starts to wet. The alarm is 0usually loud enough to wake the parents as well as the child.
The principle behind the alarm is to associate the need to urinate with waking up and holding back urination. As use of the alarm is continued, the child learns to awaken sooner into the process of emptying his bladder and to stop urinating until he reaches the toilet. Eventually, the child learns to wake up to urinate before the alarm rings and while he is still dry or to withhold urination until morning.
Those who have tested the alarms say that they are effective in 75 to 85 percent of cases within a week to a few months, and that bed‐wetting rarely returns when use of the alarm is stopped. No ,adverse effects have been noted, nor does the elimination of bed‐wetting lead to the expression of some other undesirable behavior. However, many physicians regard these alarms as offensive to the child and disruptive of the entire household.
Exercises. Pelvic tilting exercises, in which the child arches his pelvis 15 times, three times a day, are said to be helpful and may be used in conjunction with an alarm or drug treatment. The child may also be helped to expand the size of his bladder by having him drink lots of fluids during the day and then holding back urination as long as possible. While some • experts say that helps to restrict fluids late in the day, others say this is useless and may make the child uncomfortable.
Relaxation. This approach, as described by Dr. Olness, is designed to reinforce the child's self‐control over nighttime urination. First the child is made to feel very relaxed by having him think of comforting things. Then he is given very precise instructions on what to do when he needs to urinate. He is taught to focus on the good feeling of waking up in a dry bed.
This method, which takes from a few weeks to a year, is said to be 85 percent effective in children who have tried no other treatment, and 75 percent effective in those who have failed with other methods.