First and foremost, remember that for the vast majority of children with enuresis will eventually resolve on their own as their central nervous system matures. (Each year after the age of six, 15 percent of children who still have enuresis, spontaneously stop wetting at night.) Enuresis is not of disobedience or weakness of character. Steps can be taken to eventually reach one of two satisfactory goals: Your child holds urine through the night and then voids into the toilet or potty-chair in the morning, or your child awakens during the night when his bladder is full and voids into the toilet or potty-chair.
The following measures may help a child with enuresis:
- Encourage fluid intake during the day and discourage drinking liquids after the evening meal or within two hours of bedtime. If your child wants a drink before bed, limit intake to one or two ounces.
- Have your child empty his bladder just before he goes to bed.
- Encourage your child to get up during the night to urinate. A child who feels that his only goal is to delay emptying his bladder until morning may fail repeatedly. Giving verbal cues before bed (“Try to get up and use the toilet if your bladder feels full”), leaving the light on in the bathroom, or providing a potty-chair near the bed can help. To a degree that is appropriate for his age, let him participate in the cleanup process when the pajamas and bed are wet. This should be presented not as punishment but as a matter-of-fact routine. This can include rinsing out his pajamas and underwear and taking a quick bath or shower in the morning if he smells of urine. Sheets can be left open to air dry but should be washed when they have a disagreeable odor. A dry towel placed under the child’s bottom may help reduce the amount of laundry. A school-age child who wakes up wet during the night can change his own pajamas and place a dry towel over the wet area of the sheet. (Dry pajamas and towel should be made readily available in his room.)
- Some experts believe that specific measures can increase the functional capacity of a child’s bladder. Younger bedwetters who visit the bathroom frequently during the day can be encouraged to go less often. Children older than six or seven can be encouraged to try increasing the bladder’s capacity by a simple exercise of waiting to use the toilet for at least ten or fifteen minutes after feeling the urge to go. This should only be done if the child is a willing participant and will be most helpful with a child who has a small bladder capacity. (To check his capacity, have him hold his urine as long as he can and then void into a measuring cup. Take the best of three measurements of his bladder capacity, which in ounces should equal his age in years plus one or two.)
- Protect the mattress with a plastic cover.
- Offer praise and perhaps a smiley-face sticker on the calendar when he has a dry night or awakens and uses the toilet.
- Avoid expressing dissatisfaction, dismay, or anger when he’s wet in the morning.