managing the wetting

by Diane K. Newman, RNC, MSN, CRNP, FAAN

The problems of bed-wetting and daytime incontinence in a child cause severe disruptions to the family routine. Most of the parents' frustration is over their inability to help their child and the daily chores associated with changing and washing clothes and bed linens. In desperation, many parents leave the child in diapers well past the age when they are appropriate.

Children should be taken out of diapers and use products such as "pull-ups" which are similar to regular underwear by the time they are four or five and protect their bed with layered under-pads. Many mothers have told me that the Kimberly Clark Pull-ups® have been lifesavers since they provide protection and are acceptable to the child.

Never punish a child for wetting his bed or clothes. He or she cannot control the bed-wetting or incontinence and punishment usually makes the problem worse. In many cases, punishment increases the child's shame and embarrassment. Instead, use positive reinforcement for any success at staying dry by marking a calendar when the child has a dry day and/or night and celebrating the child's success with stars and stickers. This is very effective at decreasing the incidence of wetting. Identifying achievable goals, staying dry one night a week, for example, can be helpful.

Try to make it easy for your child to spend the night at a friend's house. Hiding a pull-up in the bottom of an overnight bag will allow the child to discretely slip it on. Let the friend's parents know about the problem -- they are usually very understanding about a child's incontinence.

Children who have dysfunctional voiding may need intermittent catheterization as an additional treatment. When introducing self-catheterization in children with normal perineal sensation, be patient and take time for the child to overcome the fear of pain.

Common Bladder Disorders in Children

The following disorders are seen in children that do not have nerve-brain damage to the bladder and urethra (mostly girls):

Disorder	Signs, Symptoms and Causes
Urge Syndrome	Attacks of sensation of needing to void several times a day, in which the urge sensation is countered with maneuvers such as squatting (causes the pelvic floor muscles to contract thus preventing bladder emptying). Pain and urinary incontinence may occur. Cause is detrusor overactivity with small amounts of urine in the bladder. Defecation (bowel movements) may be postponed causing constipation and/or bowel incontinence.
Dysfunctional voiding	Recurrent urinary tract infections. Voiding is less frequent. Cause may be constipation and pelvic floor muscle overactivity (pelvic muscle overactivity - repeated contractions prevent bladder from emptying).
Lazy Bladder Syndrome	Voiding occurs by increasing intra-abdominal pressure through straining or applying pressure to the suprapubic area (over the pelvic bone). Recurrent urinary tract infections and infrequent voiding are seen. The urge sensation is not present.

Last Updated: April 2003