Bedwetting is a disorder that affects many children but is an underestimated problem. The term “enuresis” refers to the involuntary emission of urine during sleep. Although bedwetting is the most common chronic disorder among children after allergies, bedwetting is often not dealt with correctly by many parents. The disorder can begin to be talked about from the age of 5, age in which the urinary tract is now mature.
Based on the cause, it is customary to distinguish three different forms of the problem for an accurate diagnosis. Central is the role of the pediatrician, who already at 4-5 years old (not at 8 years old, as it still happens most of the time) after having visited the child, makes the parents fill in the voiding diary to recognize the type of enuresis, so to prescribe an adequate therapy. In the most serious cases (when the bed is wet almost every night) it is necessary to follow a drug therapy, but the role of parents is also fundamental, who must always keep a positive attitude, without neglecting the problem.
“It is good to start with some good habits first of all – explains Dr. Antonio D’Alessio, pediatric urological surgeon and pediatrician, director of the Complex Operating Unit of Pediatric Surgery of the ASST Ovest Milanese, Hospital of Legnano – such as peeing before going to bed, drinking a lot during the day but shortly after 6pm, reducing salty and calcium-rich foods and fighting overweight and constipation. Only in the most severe forms of enuresis can drugs be prescribed based on the triggering cause: the synthetic antidiuretic hormone when the problem is due to the reduced production of ADH and anticholinergics if the origin of the disorder is the difficulty in controlling the bladder. Finally, for mixed forms, both drugs must be taken “.
“Right now – continues Dr. D’Alessio – the health emergency has led to an increase in stress and anxiety in children and families. Initially it was also thought that the lockdown could guarantee better family control of good habits, both those related to hydration and nutrition, but in reality this was not the case. The profound changes in the way of life, the change of rules in the sleep-wake cycles, the dilated schedules and the increase in stress, which directly affects the hormones that regulate diuresis, have complicated the initial picture, affecting the symptoms and favoring, in some cases, a symptomatic picture of a “rebellious” and “overactive” bladder. This has caused the problem to worsen or regressions. In all cases in which “relapses” are recorded, it is good to inform the professional, reconstruct the voiding diary and not abandon the therapy and trust in the remission of the problem “.
The psychological aspect must never be neglected. Bedwetting always involves experiences of discomfort, both in the child and in the family that has to deal with the problem. “What is important to highlight – suggests Dr. Emiliano Monzani Psychiatrist and Director of the Department of Mental Health and Addiction of the ASST of Bergamo Ovest – is that children communicate through the body, because they struggle to express negative emotions through verbal language. , stressors or emotional distress “.
In infantile emotional expression, the body is always “ahead” of words. For this reason, imbalances in physiological functions related to sphincter regulation or nutrition, are often an indicator of something that is being unregulated.
What are the alarm bells?
“That of parents first of all, but also of educators and clinicians when involved, must always be an all-round vision – continues Dr. Monzani – it is always advisable to explore the family climate, ask if there have been important changes in family ties or if there have been events that have involved emotional stress such as separations, bereavement, early or prolonged hospitalization of the child and one of the attachment figures, the birth of a sibling; events that may have led to a change in life habits, such as in this case the difficult situation linked to restrictions from health emergency. On the somatic level, children often express their discomfort precisely with the lack of control in the sphincter regulation, therefore with enuresis or in the most serious cases even with encopresis, the symptoms that often recur are stomach pain, headache, eating disorders, hyporexia, selectivity of some foods, or on the contrary, voracity, induced vomiting. Parents must also pay attention to hyperactive behaviors, sleep disorders, if there are recurrent nightmares, problems at school in the learning sphere, or in the social sphere such as aggressive behaviors towards people, animals or objects, intolerance to frustration, or separation anxieties, avoidance behaviors, fear of the dark or of animals or intolerance to detachment from primary caregivers “.
How to advise parents?
“It is important to explain to parents that psychomotor development never has a linear trend, even in its physiological nature. Having a delay in the acquisition of autonomy or skills, or a setback, does not necessarily mean the structuring of a future disorder. For this reason – adds Dr. Monzani – the sensitivity of the parent is very important. An important message to pass on to parents is that children are watching us 24 hours a day. Primary caregivers are role models, so parents who exhibit anxious behaviors are more likely to facilitate the onset of anxious reactions in their children. It is always good to avoid blaming or frightening children ”.
How to deal with the problem?
If parents feel it is difficult to cope with certain behaviors or problems that they observe in their children, they can contact them first to a professional, to find solutions to the advantage of resolving the malaise that concerns that family, of which sometimes the symptoms of the children, are the obvious manifestation. The more the context is reassuring and caring and capable of providing the right emotional “temperature”, the more it allows emotions to find adequate ways of expression, avoiding emotional blocks or short-circuits. Precisely to raise awareness on the subject, World Enuresis Day enters the calendar on 25 May, the aim of which is to promote dialogue with health professionals to raise public awareness.