Definition The word enuresis is derived from a Greek word meaning to make water. The term is used to refer to wetting by night or day, and night-time wetting is referred to as nocturnal enuresis (NE). NE can be divided into primary nocturnal enuresis (PNE) and secondary nocturnal enuresis (SNE) forms: if the child has experienced a minimum 6-month period of continence before the onset of the bed-wetting, the NE is considered SNE.
Psychological and social impact With PNE, psychological problems are almost always associated, although rarely the cause. In contrast, psychological problems are a possible cause of SNE. The co morbidity of behavioural problems is 2-4 times higher for children with NE in all epidemiologic studies. The emotional impact of NE on a child and family can be considerable. Children with NE are commonly punished and are at significant risk of emotional and physical abuse. Numerous studies report feelings of embarrassment and anxiety; loss of self-esteem; and effects on self-perception, interpersonal relationships, quality of life, and school performance. A significant negative impact on self-esteem is reported even in children with enuretic episodes as infrequent as once per month.
Diet and Lifestyle The most important reason to treat NE is to minimise the embarrassment and anxiety of the child and the frustration experienced by the parents. Most children with NE feel very much alone with their problem. Family members with a history of NE should be encouraged to share their experiences and offer moral support to the child. The knowledge that another family member had and outgrew the problem can be therapeutic. Keen attention to a normal daytime voiding pattern is important. With voiding, the child should relax, use optimal posture, and take time to completely empty the bladder. Diet - Children should be instructed not to drink to excess with the evening meal and to minimise fluid intake after mealtime. Common sense modifications of fluid intake are necessary to maintain hydration in children who play sports or who are otherwise physically active in the evening after mealtime. Some children may respond to food allergy / intolerance with enuresis. Avoidance of known allergens is recommended. Avoiding apples and apple juice may be beneficial.
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