Bedwetting or enuresis is defined as repeated, spontaneous voiding of urine during sleep in a child of five years or older. Children are said to have primary nocturnal enuresis if they have never managed to attain bladder control, and to have secondary enuresis if incontinence recurs after six months of dry nights.
While it is not a serious medical disorder, bedwetting can have a considerable impact on the lives of the children, affecting their self-esteem and socialization, and it can also cause stress in their families. The keys to resolving the issue are understanding and patience. The good news is that this problem often resolves itself over time.
When does bedwetting stop?
Most children (85%) stop wetting their beds from the age of three and before the age of six. This happens for two reasons. First, the bladder will send a signal to the brain saying that it is filling up with urine, and the brain will return a signal telling the bladder to relax so it can hold more urine. Second, if the bladder cannot hold all of the urine overnight, it will keep sending signals to the brain until the child wakes up to go to the bathroom.
Regarding the remaining children, bedwetting will occur if there is a delay in learning one or both of these skills. At what age should you worry?
Firstly, if your child has passed the age of five and still has permanent or frequent bedwetting, and he is bothered or embarrassed by the condition, it is worth visiting a urologist.
It is important to recognize that the process of urination is not under voluntary control, and parents should reassure the child that the bedwetting is not his or her fault. The communication signals in the nerve and muscle groups linking the brain to the bladder are very complicated, and this explains why bladder control improves with age as the child develops.
Secondly, if the child has reached school-age with enuresis, this usually justifies prompt intervention, particularly if enuresis is frequent and the child is depressed or distressed.
Causes of bedwetting
Most children do not have a disease process behind their bedwetting. However, formal studies have shown an increased risk in bedwetting if one, or particularly both, parents wet their beds when they were children. Primary nocturnal enuresis is caused by a disparity between bladder capacity and urine production, and failure of the child to wake up in response to a full bladder. The less-common secondary enuresis develops due to psychological or behavioral problems.
As we can see then, bedwetting is a complex phenomenon, and physical and psychological causes can include:
• No decrease in urine production at night: The body releases vasopressin at night, and this hormone reduces the amount of urine the kidneys make. It is believed that some children’s bodies do not create enough of this hormone, leading to bedwetting.
• Diminished bladder capacity: Bedwetting children often have a smaller bladder capacity than other children.
• Constipation: Parents are often surprised to find that when constipation is treated, bedwetting stops. A build-up of stool in the rectum pushes against the bladder and can affect it in two ways. Firstly, it can lower the capacity of the bladder and affect how well it empties on urination. Secondly, the pressure can ‘confuse’ the nerve signals, creating the impression that the bladder is full.
• Arousal disorder: This refers to an inability to respond to the body’s signals that it is time to urinate; instead the child sleeps through them.
• Psychological factors: Following a period of stress, or alongside psychological problems or a trauma, a child may develop secondary nocturnal enuresis or a return of bedwetting they had outgrown.
Treatment of bedwetting
Urologists are skilled in helping children with both simple and complicated types of bedwetting.
Treatment will vary depending on how old the child is, the frequency of wetting, the impact on the family, and any symptoms that may be -associated with the bedwetting. Both pharmacological (medicines) and behavioral treatments exist. To better combat the problem, a combination of treatment modalities may be used if necessary. Unless an underlying medical cause is identified, primary and secondary bedwetting are treated the same way.
Our urologists will also be able to advise on what parents can do to reduce the stress related to nocturnal enuresis, and practical measures you can take to manage the condition.
It is important to keep in mind that bedwetting is not the fault of the child or the parent. No one should feel embarrassed or ashamed of the situation.