May 25 is World Enuresis Day. A widespread but underestimated disorder: what to do and how to deal with the problem
World Bedwetting Day
Bedwetting is a common complaint in children. But what is it? IS’ involuntary passing of urine in sleep. Interest well two 2 million Italians. Of these, more than 1.2 million are children and adolescents between the ages of 5 and 14.
The May 25 is World Enuresis Day, established by the International Children’s Continence Society (ICCS) and the European Society of Pediatric Urologists (ESPU). The purpose of this day is to promote dialogue with health professionals to investigate the causes (familiarity, reduced production of antidiuretic hormone (ADH), difficulty in bladder control, psychological contributing causes) and seek solutions. It is worth remembering that, despite being such a widespread disorder, it is still underreported and sometimes untreated.
In this article
Pee in bed: it is not mentioned
What are the advice and observations of the experts? Contacting the pediatrician is essential, but a telephone survey on a sample of 13,000 families revealed that 61% of patients with enuresis (over 700,000 children) have never consulted a pediatrician and 16% of them are over 12 years old. In reality, the estimated prevalence, i.e. the number of children who suffer from it, is higher than one might imagine: in preschool age it affects one in five children, at the age of 10 it is about 1 in 10 and 3 out of 100 children in the 15-20 age group. After allergies, bedwetting is considered the most common chronic condition in childhood.
Central is the role of the pediatrician, who already at 4-5 years old (not at 8 years old, as it still happens most of the time) and, in any case, at the time of entry to elementary school, with a few simple questions could he should check if the child wets the bed before this disturbance leads to frustration and the child to a loss of self-esteem.
How to diagnose bedwetting
Bedwetting, divided into three types, it is a disorder that can be talked about from the age of 5, when the urinary tract is now mature.
In cases where the problem depends on a deficit of the normal increase in the nocturnal production of the hormone ADH, it is in the presence of “monosymptomatic enuresis”.
Sudden contractions of the bladder muscle
In other cases, the problem is due to sudden contractions of the bladder muscle, not inhibited by structures in the brain that should keep them in check.
Finally, there is the so-called “mixed form”, characterized by the simultaneous presence of both causes.
It is then usual to distinguish:
- primary enuresis, when the child pees in bed almost every night and there has never been a period of at least 6 months in which he has left the bed dry,
- secondary enuresis, in which the child’s psychological problems play a relevant role and which occurs after a period of at least 6 months in which the child has not wet the bed.
The pediatrician, after having examined the patient, has the parents fill in the voiding diary to recognize the type of enuresis, in order to prescribe an adequate therapy. In the most serious cases (when one gets the bed wet almost every night) it is necessary to follow a drug therapy, but the role of parents is also fundamental, who must always keep a positive attitude, without neglecting the problem.
Good prevention habits
“It is good to start with some good habits first of all” explains Dr. Antonio D’Alessio, pediatric urological surgeon and pediatrician, director of the Complex Operating Unit of Pediatric Surgery of the ASST Ovest Milanese, Hospital of Legnano (Milan) – such as:
- pee before going to bed,
- drink a lot during the day but shortly after 6pm,
- cut down on salty and calcium-rich foods
- and counteract overweight and constipation.
“Only in the forms more severe bedwetting drugs may be prescribed based on the triggering cause: synthetic antidiuretic hormone when the problem is due to the reduced production of ADH and anticholinergics if the source of the disorder is difficulty in controlling the bladder. Finally, for mixed forms, both drugs must be taken “.
The psychological aspects
“The psychological aspect must never be neglected – explains Dr. Beatrice Casoni, psychiatrist at the Quisisana Clinic in Ferrara and Neurocare Bologna – whether it represents the triggering cause of the problem or highlights theexpression of an organic problem. Bedwetting is always a complex issue. The context in which the child lives is also of importance: family interactions, any life changes (separations, birth of a sibling, general emotional climate) are aspects that can affect not only the causes, but also the improvement of the disorder. The psychological aspect must always be taken into consideration to clarify the emotional and relational experiences of a child. Emotions and moods should be investigated to understand if there are experiences of anxiety and fear that, although not manifested during the day, find expression during the night, when control is lost. It is good to pay attention to the more or less explicit requests of the child for help, ask him what he feels, what he feels, in order to face the problem without losing his temper, together with the child, and to make him participate in the therapy. The little ones should never be punished, but understood and supported.
And to avoid repercussions on self-esteem – continues Dr. Casoni – it is good to explain to parents that the child should never be judged, laughed at or reproached. It is also important to allow mom and dad a listening space: in fact, often even a mother can feel inadequate when she can’t solve the problem. Establishing a serene climate of dialogue within the family, also sharing the concerns of adults, allows the whole system to release the pressure, easing the tension on the problem “.
In short, the approach to bedwetting can be exemplified in three steps:
- take away any sense of guilt from the child;
- explain to him that it is a frequent condition (1 in 10 children suffer from it and three and a half million children wet the bed every night);
- express understanding of his discomfort by talking to the pediatrician about the problem.