Behavioural Modification
Ideally, children aged >5 years should have acquired proper bladder and bowel behaviour that includes passing urine five to seven times during the day and passing a soft stool regularly (daily or on alternate days). To achieve optimal response to management of MSE, it is essential to explain to parents the importance of normal bladder and bowel emptying and to correct behaviour that may result
Ideally, children aged >5 years should have acquired proper bladder and bowel behaviour that includes passing urine five to seven times during the day and passing a soft stool regularly (daily or on alternate days). To achieve optimal response to management of MSE, it is essential to explain to parents the importance of normal bladder and bowel emptying and to correct behaviour that may result in poor emptying.
- Toilet time after breakfast and before going to school is required to reduce the need to hold urine and stool passage while at school.
- Explanation of the ideal position for children to sit on an adult toilet (leaning forward with feet slightly apart and resting on a low bench so that the knees are slightly higher than the hips, and use of a toilet ring, if necessary, so that the child does not feel as if they are falling into the toilet).
- Discussions with teachers to encourage children to go to the toilet during school breaks (such as recess and lunch) and to ensure that school toilets are acceptable.
Parents of children with primary enuresis should be counselled as follows:
- Restrict fizzy drinks, caffeine and drinks with colourants. Water is the choice for fluids. A guide on recommended fluid intake in children is available (https://www.ouh.nhs.uk/patient-guide/ leaflets/files/120806fluidmanagement.pdf).
- Waking the child up and lifting them from bed should not be encouraged. Create a schedule for frequent voiding.
- Only remove nappies once the child has had consistent dry nights.
- Understand the child’s condition and avoid critical comments if the child’s bed is wet.
- Use a star chart, with the child’s involvement, to demonstrate scheduled voiding and fluid intake.
- Explain to the child, in simple terms, why medication is being used.
The South African Medical Journal_The South African guidelines on enuresis: 2024 update_November 2024; Vol. 114, No. 11