17.3.3 Treatment of enuresis
Most parents will manage their child’s enuresis problems in their own way and you may therefore not see many children with enuresis. However, the way the parents manage enuresis may affect the child negatively. Your role is mainly in educating parents about the most effective approaches (see Box 17.4).
Box 17.4 Specific recommendations for managing enuresis
- Waiting — most enuresis is due to a delay in maturation. By waiting a little, the child can often achieve bladder control without intervention.
- Parents should know that punishment does not work. Enuresis is not a condition that a child can control and punishment damages a child’s self-confidence. Some children with enuresis develop behavioural problems, such as disruptive and aggressive behaviour. These behavioural problems can get worse with punishment.
- Parents can try a procedure called dry bed training. In dry bed training parents follow a strict schedule with the child. They make sure that the child urinates at normal times during the day and evening and does not hold urine for long periods of time. They make the child urinate before going to sleep and also wake the child up at night to let them go to the toilet. The goal is to get the child to wake up by themselves in the longer term. Parents should not restrict fluid excessively. Dry bed training however has limited success.
- Parents should praise the child when they have dry nights. But when the child wets the bed, they should ignore it and appear as if they have not noticed.
If you think the child may have underlying physical health problems, you should refer the child to the nearest healthcare facility.
When these methods are unsuccessful the child may be referred for further assessment and treatment, e.g. using medication. If you suspect underlying physical causes, such as infections, diabetes or problems with the bladder, the child should also be referred.