Bed Wetting in Children
Posted on September 1st, 2010

Dr RuwanM Jayatunge

Bedwetting or nocturnal enuresis is involuntary urination while asleep after the age at which bladder control would normally be anticipated. A large number of young children and teenagers wet the bed every night. It is an agonizing problem to the both children and to their parents. Children feel agitated sometimes depressed over bed wetting and they often have low self-esteem and low self confidence.

 By five years old, most children have successfully stopped wetting the bed without any intervention. Among those children who still wet the bed after the age of six, most will complete the bed-wetting stage and stay dry at night within the next year without any treatment. Two percent of adolescents still wet the bed at fifteen years old.

 Although child’s bed wetting is a disheartening issue for the parents most children grow out of it and bed wetting can be considered as a temporary problem. Only a few percentages find difficult to get over with it and need medical and psychological mode of management.

 Bedwetting is a complex problem with multiple medical, physiologic, behavioral, and environmental causes. Bed-wetting has a genetic link and seems to run in families. The likelihood of a child wetting the bed is 40% if one parent suffered and 70% if both parents suffered. Some researchers view bed-wetting as a psychological problem. Some children do wet the bed if they have anxieties at home or school. Psychodynamic theory views enuresis as an expression of underlying emotional conflicts.  Severe sibling rivalry, separation anxiety, child abuse, family violence can trigger bed wetting.

 Physical Causes of Bed Wetting

Some children bed wet due to various types of physical causes. Children with smaller functional bladder capacity   can hold less volume in their bladders before feeling the urgent need to urinate.  They tend to pass urine involuntarily while sleeping.   Obstruction or structural anomalies in the urinary system too can cause similar problem.  
Urinary Tract Infection (UTI) gives urgency and frequency of passing urine and children who suffer from UTI often become nocturnal bed wetters

 Psychological Causes of Bed Wetting   

Any distressing situation that causes the child sudden emotional instability can cause serious psychological strain which physically manifests itself in bed wetting.    Psychological stresses like crises in the family (violence, deaths, separation) school phobia, child abuse, extreme bullying, witnessing violent accidents or disasters may give rise to nocturnal involuntary bed wetting.  Frustration and emotional scarring that are associated with the wetting.  Very often teasing, demeaning self esteem, social restrictions are associated with the child’s problem.  Sometimes children are punished for bed wetting and the problem tends get aggravate.

  Little Tips for the Parents

 1) Do not punish or humiliate the child. Punishing or humiliating a child for bed-wetting would   make it worse

 2) Give the child most of his or her fluids in the morning and afternoon and limit fluids at night especially 2 hours before bed time.

 3 Have your child use the toilet before he or she goes to bed.

 4) Use self awakening training. This is a method of helping a child awake from sleep. It involves having the child practice getting out of bed to go to the bathroom. This type of training works well when both parents and the child are motivated, and usually this is more likely with children older than 6.

 5) When the child goes to sleep stroke his hair and say don’t wet the bed tonight

 6) Keep a record of his “dry nights continue providing praise, encouragement, and rewards for his success

 Treatment for Bed Wetting

 Bed-wetting alarms

 Bed-wetting alarms (enuresis alarms) are suitable for children older than 7 years. They ring or buzz when child begins to wet the bed.  The basic concept is that a sensor is placed in the underwear which will cause the alarm to ring at the first drop of urine. The purpose of the alarm is to wake the child up so that he will either stop wetting or go to the bathroom to urinate.

  Medication

When the child displays an unusually low level of self-esteem or a high level of depression medications are prescribed by a qualified physician. Imipramine being the drug most prescribed for enuresis. Parents must not medicate the children without proper medical advice.

 Psychological Therapies

Psychological treatments for children with enuresis without an evident cause are varied.  Bed-wetting is affecting a child’s self esteem performance in school, or relationships with peers. Children with bed wetting following emotional problems need professional counseling. Problem solving counseling would help to give insight and reduce bottled up negative emotions. Play therapy and music therapy also help to reduce psychological stress that is experienced by the child. Positive reinforcement and behavior modifications can eliminate the psychological causes of bed wetting. Motivational therapy involves parents encouraging and reinforcing a child’s sense of control over bed-wetting.

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