Enuresis or bed-wetting refers to involuntary passage of urine while asleep. It is a common problem in infants and young children. It is regarded as a period of adjustment. By the time a child reaches the age of two years, he can usually learn to control the passage of urine during the day. However, it may be another year or so before he can achieve control all through the night.

Enuresis may be primary, in which case normal control was never achieved at any stage, or enuresis may be secondary, where the child starts wetting the bed after an initial period of normal bladder control. Bed-wetting in certain cases may go on until the fourth or fifth year, without the child being abnormal. Even then the best trained child may fail to live up to expectations on certain occassions, when he is highly excited. Some children are chronic bed-wetters all the way into their teens. This situation becomes one of irritation and concern for the parents.

Causes

Most cases of bed-wetting are caused by psychological or emotional disturbances, generally resulting from lack of security, resentment or anger towards parents, fear and anxiety. This may account for as many as 90 per cent of cases. The remaining 10 per cent cases may be due to worm infestations or urinary tract infections, diseases like childhood diabetes, paralysis of spine and epilepsy. Enuresis may also appear during serious illnesses.

Treatment

Punishment plays no part in the successful treatment of this condition. The child should not be made to feel guilty. This may cause him to lose confidence in himself and rob him of his self- respect.

The parent should ensure that the child who faces this problem has plenty of sleep and rest and a pleasant home environment. The following suggestions may help the child overcome the problem of bed-wetting.

1. Reduce the amount of fluid just before child goes to bed. Do not be unreasonable, especially on a hot night, for the more concentrated urine may be irritating the child and causing him to lose control of his bladder during sleep.
   
2. Do not be overanxious about this problem. Making an issue of it may only prolong the problem. Try to keep the child relaxed, even if he is a little slow in overcoming this habit.
   
3. Make the child void his bladder before going to sleep, especially if this is a frequent problem.
   
4. Be sure to reward him in an appropriate manner when he succeeds in keeping dry at night. Do not punish him when he fails.
   
5. Give your child a happy home of which he can be truly proud. Try to remove all friction within the family. This may help to solve not only the bed-wetting but all other nervous problems as well.

In regard to physical treatment, the child should be placed on an all-fruit diet for few days. If possible, he should be given warm water enema daily during this period to cleanse the bowels. He should also be given cold sitz bath daily. The procedure is to fill an ordinary bath tub with cold water to a depth of four inches or so. The child should sit in it in such a way so that his feet and sexual organs are immersed for the most part in water. Only the seat and feet should touch the bottom of the tub, while the knees are always above the water.

The knees should be kept apart and the water should be vigirously dashed over the abdomen with the hollow of the hand. The throwing of the water is then followed by a brisk rubbing of the abdomen with both hands. After this process has been carried on for a while, all the parts immersed in the water except the sexual organs themselves, should be rubbed vigorously with open hand and then dried with a rough towel. When the child becomes stronger, the rubbing -dry process should be carried out with the hands. This is in itself a good exercise and improves the condition of the skin.

This will help tone up the bladder. Bed-wetting in children of fairly advanced stage is usually due to mental strain, induced by over-stimulation of the brain through excessive school work, and incitement by parents to learn too much. In these cases, the child should be given plenty of rest and quiet and freedom from all undue mental activity and nervous excitement.

An excellent home remedy for bed-wetting is the use of mixture of sesame seeds (til) and bishop’s weed (ajwain). About 24 gms. of sesame seeds should be mixed with 12 gms of ajwain and 36 gms. of jaggery. About 6 gms. of this confection should be given to the child in the morning and evening. This will bring good results.

Fresh air and outdoor games are also helpful in the treatment of bed-wetting in children. The child should be encouraged to spend as much time outdoors as possible and play outdoor games in preference to indoor ones.