Bed-wetting, otherwise known as nocturnal enuresis, can be a very embarrassing problem for children, and an equally distressing one for parents. It can potentially affect the self-esteem of a child if not managed properly. Generally, bed-wetting before the age of 6 to 7 is not a cause for concern. In early childhood, night time bladder control may simply not have matured. There may be a hereditary component, and is generally more common in boys.
Enuresis can be classified as:
• Primary Enuresis – in which there has never been a dry night from the beginning.
• Secondary Enuresis – in which the child was dry for at least 6 months before the onset of bed-wetting again.
Most children overcome bed-wetting as they get older, typically resolving by the age of about 5 years. However, the problem may persist for some beyond that, and it can be a cause for distress and shame. The important thing for parents to understand, is that a child rarely bed-wets on purpose, so scolding or other forms of reprimanding are usually not helpful.
• Children have small bladders which get filled up very quickly.
• Young children often do not realize when their bladders are full.
• The urinary sphincter muscles, whose job is to stop the urine from leaking out of the bladder, are generally not very mature in children, thus occasionally losing control, especially during sleep, when the conscious mind is at rest.
• Deep sleep may cause unconscious emptying of the bladder.
• Stress or bad dreams. Events such as starting school or becoming an elder sibling may trigger bed-wetting.
• Some kids do not produce enough anti-diuretic hormone. This hormone tells the kidneys to release less water.
• Medical conditions such as diabetes, urinary tract infections, chronic constipation, brain and spine conditions eg. Cerebral palsy and spina bifida.
• Bed-wetting was previously believed to be a chiefly psychological issue, and many children were made to see psychiatrists and counsellors. However, psychological treatment has been found to be ineffective in the majority. It is now known, that the majority of bed-wetting children do not have a primary psychological problem. Instead of scolding a child who wets the bed, parents and caregivers should try to give positive reinforcement and encouragement when he or she remains dry.
Treatment is usually not required for bed-wetting in children less than 7 years of age. Most will learn to control the bladder over time, even without treatment.
However, in a child older than 7, who wets the bed at least 2 times a week for at least 3 months, professional help may be sought. The child should also see a doctor if it starts to affect the child's self-esteem, homework and peer relationships.
Treatment would generally focus on positive reinforcement, a moisture alarm and behaviour therapy. Occasionally, medication may be prescribed.
Steps that may help:
• No late night drinks close to bed time
• Make it a habit to empty bladder just before bed time
• May have to wake child in the middle of the night to pass urine
• Positive reinforcement whenever a child remains dry
• Seek professional medical help if the problem persists
The article above is meant to provide general information and does not replace a doctor's consultation.
Please see your doctor for professional advice.