¿What is child enuresisl?     ▲

Enuresis is the bedwetting or clothing at ages where the vast majority of children have a good control over the emptying of the bladder, both day and night, which happens in the vast majority of children before the age of five.

In medicine, the term enuresis is applied when the bed or clothes get wet twice a week for at least three consecutive months or when, despite suffering the urine emissions less frequently, the disorder has a psychological impact of some importance on the boy.

Bedwetting is more common in boys, affecting 7% of this sex at five years of age, lowering the prevalence at ten years at 3% and 1% at eighteen. Among girls, the percentage of affected by enuresis is less than half the percentage in boys.

What are its causes?     ▲

There are hereditary factors in the development of the disorder. The probability that the second twin suffers enuresis if the first also have this disorder is almost 70%. Apparently, the genes involved are mainly related to chromosome 22.

It is thought that the cause of bedwetting could be different endocrine disorders or from the kidney or brain. Also, psychological problems have been detected in these patients more often than those who do not suffer from enuresis.

It is very likely that exists a delayed maturation in acquiring functions of the urinary bladder, but the origin and mechanism of this lack of maturation are unknown. In cases of secondary type, it is common to find a psychic trauma or another event type as the origin of the return to urinary incontinence.

Symptoms of enuresis     ▲

In 90% of cases, children with enuresis have never had a satisfactory control over the emptying of the bladder. This is the primary enuresis. In the remaining cases, after a suitable period of bladder control patients return to bedwetting. These cases are the secondary enuresis.

Most of the time, involuntary bladder emptying occurs at night during sleep (bedwetting or nocturnal enuresis), while in a number of patients, usually, girls, the involuntary urination occurs while being awake (diurnal enuresis) and usually happens for the delay for urinating until the last moment. In some rare cases, daytime enuresis is related to urinary tract infections, inflammation of the urethra, diabetes, stress, or urinary tract malformations.

How to treat enuresis     ▲

Ideally, the therapeutic approach to enuresis should begin with behavioral treatment, ie, with modifications to behavior. However, it is common, since it is easier to implement, a system based on drugs, since both the doctor and the family see more acceptable prescribing a drug treatment that a behavioral treatment, which requires more and continued efforts by the patient and their parents.

Behavioral treatment

You need to explain to the child what will be the plan to follow and get her consent and cooperation to achieve control bladder emptying. Without the active collaboration of the child, any attempt to treat through behavior-based therapy is doomed to failure. It should be noted that the most interested in getting staying dry at night is the child himself, who also suffers frustrations and tensions that bedwetting causes to the whole family.

It is useful a calendar or a quadrant where the patient can register the days when stays dry overnight. The parents should always highlight the achievements of the child. Every achievement must be accompanied by an appropriate reward proportionally to the magnitude of what have been achieved. It is recommended that the reward offered also have a progressive dimension so that a consecutive week of staying dry should have a greater importance than the sum of the reward of seven not consecutive nights.

A star, a sticker or a mark on the calendar, indicating the nights remained dry often are useful for the child to perceive his own progress, also serving as testimony to his effort and improvement.

The child must empty the bladder completely just before going to sleep each night.

Waking the child several times during the night not only is of little usefulness but is a source of anxiety and load directly the responsibility to maintain dry the bed on the parents and the child, when the real goal is to get the child can control the emptying of his bladder.

In contrast, it may be beneficial to wake the child only once at night, about three hours after sleeping, to evacuate urinea.

All negative stimuli should be avoided, such as reprimands, punishments or mere accusations and demeaning comments that impact harmfully on patient self-esteem and the perception of his ability to overcome the problem.

The use of alarms that detect when there has been the release of urine during sleep may be useful although it should be noted that these devices should be part of the plan of behavioral treatment by parents and should not become the only measure against enuresis. It is important to explain to the child how the system works, its advantages (better control over urination) and to get his cooperation.

If your child has secondary enuresis and the reason that caused this relapse is unknown, perhaps required the advice of a child psychologist or psychiatrist to clarify the origin of enuresis, especially if the behavioral treatment has failed.