Apart from the discomfort and distress of waking up to a wet bed, a recent review of the impact of bedwetting included one study which showed 70.3% of children aged 5-11 years could clearly indicate that wetting is a disadvantage. The types of disadvantage or negative consequences were:

• social (I can't sleep at a friend's house, friends can't stay over night - in 32.1%),
• affective (I feel sad, ashamed, annoyed - in 16.4%),
• of isolation (I feel like a baby, nobody is allowed to know about it, I feel different from other children - in 6.7%),
• of sensation (it feels unpleasant, cold, wet itchy, nasty - in 32.1%) or referred to direct consequences (I have to take a shower, sleep in pull-ups, won't get a bicycle - in 17.6%).

Other studies in the review agree with these findings. The review goes onto say one must remember that the accompanying psychological problems may subjectively be just as distressing for parents and children as the wetting problem itself. It is therefore important for all professionals dealing with enuretic children to have a basic knowledge of possible psychological problems - to be able to decide which children require help from other specialists.

Impact on Parents

In one population based study by Foxman 1986 (2), 17% worried a great deal and 46% some or a little. Most mothers worry about the welfare of their child. In another study by Butler et al 1986 (3), the greatest maternal concerns (on a scale from 1 to 7) were:

• emotional impact (5.66),
• social relationships (5.02),
• smell (3.70),
• extra washing (2.92),
• financial aspects (2.70)

Parents also believe that their child should become dry at a very early age: the mean anticipated age of dryness was 3.18 years in one study by Haque et al 1981. The causes that parents believed to be responsible for their child's wetting were emotional problems 35.5%, heavy sleeping 38.2%, physical problem 21.4%, familial problem 28.9%, small bladder 10.7%.

A minority of mothers show an attitude described as "maternal intolerance" by Butler et al 1986. These mothers are convinced that their child is wetting on purpose. They believe the child is able to control the bedwetting, they get angry with their child, do not invest energy in treatment and withdraw and even punish their child.

Frequent follow-up and emotional support and encouragement appear to be important components of an efficacious intervention for children with nocturnal enuresis. Caring for wetting children and their parents is of great help - even if, or especially when the treatment is not as successful as everyone (including doctors and nurses) would wish.

References:

1. Hjalmas et al - Nocturnal Enuresis; an International Evidence Based Management Strategy, American Urological Association, 2004
2. Betsy Foxman et al - Childhood Enuresis: Prevalence, Perceived Impact, and Prescribed Treatments, Paediatrics Vol. 77 No. 4 April 1986
3. R J Butler et al - Maternal Attributions and Tolerance for Nocturnal Enuresis, Behav. Res. Ther. Vol 24. No 3 pp307-312, 1986