Bedwetting blues

Is bedwetting a problem in your home? Read on to determine whether this condition is psychological or physical.

Training a child to use the toilet and getting him out of his diapers is always considered a pleasant milestone in your child’s life. It also gives you a sense of accomplishment, makes the baby bag much lighter, and allows for relatively more peaceful nights. In some cases, however, after a child has been dry through the night for quite some time, he may start having recurrent “accidents” of bedwetting, usually between ages five and seven. Such incidents are embarrassing for the child, and are both confusing and frustrating for the mother. She feels that it is a major setback after ending the dilemma of running back and forth to the bathroom with her child and having to change sheets every morning. The course of action taken by the family regarding this issue makes all the difference in solving the problem. The first question parents are faced with is whether to seek the help of a pediatrician or that of a psychologist. It turns out that the majority of bedwetting cases are caused by physiological reasons, so it is advisable that the following tests be conducted first. According to Dr. Ahmed Darwish, consultant pediatrician at CairoUniversityHospital, a family can pinpoint the problem, solve it, and maybe even prevent serious deterioration in an underlying medical condition.


The Physical Reasons

Test One:

Urine analysis determining the presence of:

Urinary tract infection (UTI). UTI increases the frequency of the child’s need to go to the toilet, which he sometimes can’t control. A culture is then run to find out the type of organism present in the child’s urinary tract. Medication is then prescribed accordingly.
Sugar (glucose) in urine. When sugar is present in the child’s urine sample, the doctor will run a blood test for diabetes. If the child is proven to be diabetic, then insulin will be prescribed as the doctor sees appropriate. The frequency of urination is higher in diabetic children. So instead of urinating once at night, a diabetic child will need to urinate approximately three times. It takes a diabetic child some time to adapt to going to the bathroom so often, and until he does, it is easy for him to lose control. On the one hand it is hard for a child to wake up so frequently, and at the same time, it takes him some time to realize that he actually needs to go to the bathroom that often.
Specific gravity (diabetes insipidus), otherwise known as the “absence of the anti-diuretic hormone.” This condition occurs when the body secretes large amounts of urine and the bladder cannot contain it. A supplement will be given to the child to make up for the lack of this hormone.
Test Two:

Stools analysis to look for:

Pinworm (oxyuris). This is a very small, very fine, whitish worm that lays its eggs in the anal area at night during a child’s sleep. This causes irritation which as a result causes bedwetting. The irritation and itchiness will also cause the child to scratch this area with his hand, possibly carrying the eggs to his mouth, and the cycle repeats itself. This worm is self infectious. Pinworms live in uncooked vegetables and fresh fruits, so adults are also at risk of catching this worm if they eat fruits and vegetables that are not properly washed. Try not to eat salads outside your home.
If your child’s stools test positive for pinworm, you must make sure that his underwear is washed and boiled SEPARATELY. Make sure your child wears tight underpants so that if he itches during his sleep, he does so from on top of his underwear.

Your doctor will prescribe medication to your child, and will most probably prescribe the same medication to everyone in the household – parents and domestic help included. (The medication is usually taken orally in addition to an ointment).

Test Three:

Regular x-ray on the lumber spines (lower back):

This is the area where the nerves attach to all body organs. One of these nerves is the one attaching to the bladder sphincter. In some cases the vertebrae are compressed causing the nerve to be under more pressure than usual. When this happens, the compressed nerve will cause the sphincter to become somewhat numb, where uncontrollable urination may occur. Treatment will be through muscle and nerve stimulants, in addition to exercises for the sphincter.
The Psychological Reasons

According to Dr. Emina Kartal, child psychologist, there are psychological reasons for bedwetting as well, as it may be an indication that your child is experiencing some insecurity or going through an unhappy phase. Dr. Kartal adds that bedwetting can occur if a child is subjected to a traumatizing or a severely shocking situation. This does not mean, however, that bedwetting will happen more than a few times. She says that most of the reasons are in fact physiological.

It is more common nowadays for families to seek therapy for the problem of bedwetting unlike in the past when such a matter was a source of embarrassment for the family. Therapy, when needed, can be done by combining talking with art and play. During play, a therapist can read a lot from the child’s play choices. With time, a child is more likely to open up to his therapist and talk. “A problem externalized, is a problem half solved,” says Dr. Kartal.

Bedwetting Tips!

Dr. Kartal’s advice on how to cope with bedwetting:

Try to stay as calm as possible and do not let your own distress reflect on your child. Yelling will only make your child more nervous and frustrated with himself because he can’t really control the bedwetting.
Get help. Don’t be shy and don’t look the other way.
Be convinced and convince your child that bedwetting is a medical condition that will go away with the right treatment, and that he shouldn’t feel guilty about it.
Limit liquid intake to two hours before bedtime.
Tell your child to go to the toilet right before bedtime.
Make an extra effort to take your sleeping child to the toilet in the middle of the night and another time closer to dawn. This way you can minimize the occurrence of bedwetting.
Never expose your child’s embarrassing problem in front of others. Try to keep this issue hidden – even from his own siblings if possible!

Never hold bedwetting against your child or threaten to expose him. You will lose on all fronts. Your child won’t get better and you would’ve lost his trust for good! Children are very sensitive.
Cover the mattress with plastic padded sheets to keep it from getting wet.
Be patient. This problem, if treated, should not stay with your child beyond the age of 11.

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