Bedwetting

What is bedwetting?

Incidence of bedwetting

Causes of bedwetting

Bedwetting risk factors

Remedies for bedwetting

References

What is bedwetting?

Bedwetting (enuresis) is involuntary urination while sleeping, when the person should be old enough to control their bladder.

Most bedwetting is just a delay in development and not an emotional problem or physical illness. It is a common complaint made when visiting doctors, and often runs in families.

Incidence of bedwetting

Most girls become reliably dry at night between the ages of 3 and 6, and boys by the age of 7. During preschool years about 40% of children wet their bed. By the age of 10, 95% of children stay dry at night.

If child wets the bed regularly, it is probably because he or she has not yet learned bladder control; this will improve with time. The child may need treatment if he or she continues after age 7, or starts again after 6 or more months of dry nights.

In older children, the spontaneous resolution rate is about 15% per year and the child may simply outgrow the problem.

Studies place adult bedwetting rates at 0.5% to 2.3%. (1)

Causes of bedwetting

Physical

• Sense of bladder fullness. Infants are not able to control their bladders. Most children start to sense when their bladders are full between one and two years old. Between the ages of two and three they start to develop a sense of bladder control and stay dry during the day, and between four and five they may start to stay dry overnight. A neurological-developmental delay is the most common cause of bedwetting.
• Genetic. Children whose parents did not wet their beds have only a 15% incidence of bedwetting. Where one parent was a bed-wetter, 44% of children were affected. If both parents were affected as children, then 77% of their children were affected. (3)
• Hormonal. Around sunset the body releases an antidiuretic hormone (arginine vasopressin or AVP) that reduces the kidney's urine output during the night, so the bladder is not ready to empty until wake-up time in the morning. Most children start developing this hormone between the ages of 2 and 6, and it develops in most others before the end of puberty. If it has not developed by the end of puberty, they may suffer bedwetting as adults. (1)

Psychological

• Stress or insecurity, such as lack of parental connection, parent conflict or divorce, arrival of new baby, death in the family, sexual abuse, moving residence.
• Bullying, or pressure to stop bedwetting.
• Punishment or shaming can make the problem worse. Simply having to get out of bed and go through the cleaning routine is punishment enough for most children. When questioned, children and adolescents describe bed wetting as extremely stressful. Bedwetting children face problems such as being teased by siblings; anger, punishment or rejection by parents or caregivers; being afraid that friends will find out and limits to social activities like sleep-overs and campouts.

Bedwetting risk factors

• Constipation. When the bowels are full, it puts pressure on the bladder.
• ADHD.
• Sleeping problems, sleep apnoea, insomnia.
• Bladder or urinary tract infection.
• Epilepsy.

Remedies for bedwetting

• Wait. Almost all children will outgrow bedwetting. Usually, wait until the child is at least 6 or 7 unless the condition is damaging the child's self-esteem or relationships.
• Bedwetting alarms which sound a loud tone when they sense moisture. When used properly and without additional stress or shame on the child, they have a success rate of 75-85% over a few months.
• The three Cs - caffeine, cola and chocolate. Eliminate these nasties in the evenings and late afternoons.
• Absorbent underwear / diapers / nappies can reduce embarrassment for bed-wetters and make clean-up easier.
• There is a debate about restriction of drinking in the 1 - 3 hours before bed - it may not be helpful. Of course, don't drink excessively, but neither should the child go to bed feeling thirsty.
• Of course, ensure your child uses the toilet immediately before going to bed.
• Never punish a child for bedwetting. Praise and reward your child for dry nights.
• Play a game to teach your child bladder-control. When he or she feels like urinating, hold it for few seconds. In the middle of urinating, stop for a few seconds, and then start again. Do not play unless the child asks to play.

References

1. S. Nappo, R. Del Gado, M.L. Chiozza, M. Biraghi, P. Ferrara, P. Caione. Nocturnal enuresis in the adolescent: a neglected problem. BJU International, Volume 90, Issue 9, pages 912-917, December 2002.

2. Michael W. Mellon, Melanie L. McGrath. Empirically Supported Treatments in Pediatric Psychology: Nocturnal Enuresis. J. Pediatr. Psychol. (2000) 25 (4): 193-214.

3. Fritz GK, Rockney R. Practice Parameter for the Assessment and Treatment of Children and Adolescents With Enuresis. J . AM. ACAD. CHILD ADOLESC. PSYCHIATRY, 43:12, DECEMBER 2004.