[Toilet training in mental retardation; approach to diurnal enuresis in a 12-year-old boy with hemiparesis].

Abstract

A 12-year-old boy with hemiparesis, severe mental retardation, reduced mobility and behavioural problems was not yet toilet trained. He was successfully trained using a behavioural treatment. The training program was based on gradual prolongation of urine retention, the introduction of behaviour restrictions, rewards for using the toilet and overcorrection using repeated exercises if diurnal enuresis occurred. A third of 4- to 18-year-olds with a cerebral palsy do not have diurnal bladder control at the age of 6, in contrast to 1-3% in the general population. An important cause of this difference is the believe that bladder control is dependent on the time of development of bladder control muscles and that it cannot be affected by external methods. This case study shows that even in a relatively older and severely and multiply disabled boy diurnal enuresis can be solved.