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Primary Enuresis
The cause of primary enuresis is probably rarely organic, nor is the
child usually emotionally disturbed. In most cases it is a slowness to develop
control of the bladder, which is largely a hereditary trait, and if it
could be completely ignored it would lead to spontaneous cure by the time
the child reaches 7 or 8 years. Unfortunately, it is never ignored; 30% of
mothers admitted scolding or beating the child, and those who were not
obviously disapproving made their attitude to the child's wet beds quite
plain even if they used only the kind words they claimed to use. The
result of this is that the child becomes anxious and tries very hard to
have a dry bed; as he has not yet acquired control, this is impossible and
he becomes depressed and the anxiety is reinforced. The effect of anxiety
in the enuretic as with the child with a stammer is to make the situation
worse rather than better, and a vicious circle is set up.
There are two other factors concerned. First the hereditary tendency
and secondly the habit of mothers "lifting" their children on to the pot to
urinate without waking them. 287 mothers admitted doing this with children
over 5 years old. The effect of this is to train a child to pass water in its
sleep.
Treatment
Since 1954, 1,000 children have attended the clinic more than once.
Those who attended once only and did not return for follow-up have not
been included in this series. The treatment has consisted of getting to
know the child, explaining to him why he wets the bed, particularly that
it is not his fault, and asking him to mark a card when he has a dry night
only. The card must never be marked on the wet nights, only the dry.
Placebo tablets are given - as much for the benefit of the mother as the
child, since many mothers would not return if the child was not given some
sort of medication. The comments made on the effects of the tablets have
been interesting. Several mothers reported that the tablets kept the child
awake all night. These were obviously aware of the use of amphetamines
for this condition. Some comments include "they made her faint"; "they
gave him terrible griping pains"; and "without those tablets he would
never have passed his 11+*.
No limitation of fluid is recommended. The child is told he will not
get better straight away, that the treatment will take about six months,
but that each month he will get a little better. The children are seen at
monthly intervals and always by the same person. This is of extreme importance,
the child brings the card with the dry beds marked by crosses,
to show to the doctor whom he knows. The child subconsciously brings
a gift of so many dry beds per month to a friend; he will he less anxious
to produce results for a stranger.