Bedwetting is a fact of life for many households with young children, but why does it persist for longer than it should in some cases?
What exactly is enuresis?
Bedwetting, or 'nocturnal enuresis' is the correct term given to a child's inability to control night-time urination at an age when they should be able to. Enuresis can occur for a variety of reasons, including an immature bladder, a hormone deficit, or, in some cases, due to psychological issues.
Most children master daytime control of their bladder between two and three years of age. However, dry nights can take a lot longer - with one in ten children not making it before the age of six. According to some research, approximately 15 percent of children over three years of age wet the bed while they are asleep, with boys finding themselves in this situation more often than girls.
Bedwetting is characterised in two ways:
Primary enuresis refers to children who have never successfully toilet trained to the point of controlling urination. This is the most common type enuresis (80 percent of all childhood cases).
Secondary enuresis is when a child starts to wet the bed again following a long period of overnight dryness - usually after three to six months of regular control.
Bedwetting is considered to be a medical problem if it persists past the age of five in girls and six in boys, and occurs twice a week (or more) for three consecutive months.
Why is it happening?
Enuresis can have a number of underlying causes such as sleep disorders, a slower than usual development of bladder control, or be the result of emotional or psychological stress. Bedwetting can also be due to kidney or bladder problems, but this is more rare.
Common causes of lack of urine control in children include:
- Excessive fluid intake in the evening, before bedtime.
- The child has not yet connected a full bladder with the urge to urinate.
- Hereditary causes. If parents also had enuresis, children may have a greater predisposition for it.
- Altered rhythms of sleep. If children do not sleep well during the day, they may find it more difficult to wake up in time to urinate.
- Emotional reasons. When a young child starts to wet the bed again after months or years of not doing so, these symptoms may be caused by fears or insecurities. This can happen after a child experiences some changes in his or her life, such as divorce, moving house, losing a family member or loved one, the arrival of a new baby in the family, changing schools, or other stressful situations.
- Physical problems are the least common cause, but urinary tract infections, diabetes, constipation, kidney problems or intestinal worms can all be factors in bedwetting.
Diagnosis and treatment
In order to rule out a physical problem, your doctor will carry out a physical examination, order a urine test and possibly an abdominal ultrasound.
Overcoming enuresis often requires a shared effort between parents, child and doctor. There are numerous treatment options where bedwetting persists in older children, including:
- Medication - Desmopressin is a prescription antidiuretic that, given at night, reduces the production of urine and prevents the child from wetting the bed.
- Enuresis alarms - Bedwetting alarms can be used alone or in combination with medication. When the child urinates, the device sensor gets wet and an alarm sounds. This helps to develop a conditioned reflex that causes the child to wake up in order to pee in the bathroom and not in bed.
What else can I do?
- Establish a toilet schedule - Children should aim to pee about six times or more a day (at breakfast, mid morning, lunch, late afternoon, dinner and bedtime).
- Monitor fluid intake throughout the day - Distribute drinks appropriately throughout the day. i.e. more in the morning, less in the afternoon, little at night and nothing before bedtime
- Avoid salty and liquid meals - Children who are wetting the bed should avoid consuming more than 200ml of liquid (e.g. soup, water, milk, juice, or yogurt) during dinner.
- Watch sleep patterns - As a rule of thumb, children shouldn't sleep for more than ten hours without emptying their bladder.
