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| |    The Doctor's Approach to Bed-Wetting by Robert Needlman, M.D., F.A.A.P. reviewed by Robert Needlman, M.D., F.A.A.P. If your child has a bed-wetting problem and you take him to the doctor for a medical evaluation, what sort of questions and tests should you expect? With bed-wetting, it usually is fairly easy to rule out medical causes. The doctor can then take the role of coach to help your child take control of his bladder, and in the process strengthen his sense of self-control and mastery in general. Terminology The medical term for bed-wetting is enuresis. Most children with bed-wetting problems have simply never learned to stay dry at night. Assuming that your child is dry during the day and has not lost the control that he once had, then most doctors would consider this to be primary nocturnal enuresis--that is, common garden-variety bed-wetting. If the child has been dry every night for several months but then starts wetting the bed again, the problem more likely to have been caused by another illness. Doctors call this secondary enuresis. Sometimes the line between secondary enuresis and primary enuresis is a bit blurry. As children are learning to control their bladders, they can be dry for a few weeks, then start wetting again. This happens so commonly that most doctors won't diagnose secondary enuresis until after the dry period lasts several months. Sometimes there is an obvious cause for this back-slipping, such as the birth of a younger brother or sister or a stressful event in the family. Sometimes it just happens. Physical exam and tests Most children who have primary nocturnal enuresis are completely healthy--there is nothing wrong with them other than the fact that they have yet to gain control of their bladders at night. In rare cases, there is an underlying medical, developmental, or emotional problem. Your child's doctor can check for these problems without doing any fancy testing; a physical examination and urine test is usually sufficient. If your child wets during the day or has to urinate very frequently during the day in order to stay dry, the likelihood of there being an underlying medical problem is higher, and so there may be more medical evaluation done. Constipation One other important medical condition needs mentioning here: constipation. Children with constipation often have bed-wetting problems, too. Fix the constipation and the bed-wetting often gets better. If you don't fix the constipation, all of the other treatments for bed-wetting are likely to fail. The main signs of constipation are stomachaches, hard bowel movements that might be painful to pass, several days between bowel movements, or frequent leakage of stool with staining of the underpants. The "coach" approach When I see a school-age child with a bed-wetting problem, I try to direct most of my questions and advice to the child and purposely not to his parent. Some parents may feel that this is rude of me, but there is a good reason for it. I know that for the bed-wetting treatment to work, the child will have to invest a fair amount of effort into taking control of the problem. Often, just the opposite has been the case. The parent, upset about having to change sheets all the time, has made the problem her own. She (or the dad) is the one who really cares about the bed-wetting. The child is able to pretend that it's no big deal to him. If the parent really demands my attention during the visit, I might ask pointedly, "Whose problem is this?" Generally, this is enough to get us back on track, and it usually gets a smile from the child, who knows very well what has been going on! I like to take the role of coach. A coach works with the athlete (child) to get the best performance. But it is the athlete who ultimately remains in charge. This is a pointedly nonmedical way of approaching the problem, but it is often the most effective. It is wonderful when a child can proudly report that he has solved his own bed-wetting problem.
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