Many parents get easily frustrated when they find out that their child is bedwetting. You don’t have to get mad at yourself since this is a fairly common occurrence especially among young kids who have not yet fully established bladder control. In fact, recent studies suggest that 1 to 2 out of 100 young kids suffer from enuresis, the medical term for bedwetting. But what is enuresis and why do kids wet the bed?
Bedwetting, or enuresis, is a behavior or condition whereby a child passes urine, often involuntarily. This should be differentiated from urinary incontinence whereby the individual is fully aware of the passing of urine yet lacks some of the necessary control to prevent it from being flushed out of the urinary tract. Enuresis or bedwetting typically occurs at night for which it is called as nocturnal enuresis. In some cases, it can also occur during the day, a condition called diurnal enuresis.
There are essentially two principal types of bedwetting among children. The first type is called primary enuresis and this is diagnosed in children who have never had the chance to establish bladder control. This means, since birth, they have yet to show competence in controlling the passing of urine through their urethra. The second type is called secondary enuresis. This typically occurs when a child has already learned to establish good bladder control but, for reasons still poorly understood, relapses after 6 months, unable again to control his or her bladder.
Now, there is a cut-off age for bedwetting to be considered a health problem. If the child is already 5 years old and he or she has either primary or secondary enuresis, there is a strong likelihood that an underlying medical or even psychological problem is present. In such situations, a thorough evaluation both by a pediatrician and a child psychologist is warranted. Do take note that enuresis is classified as a mental health disorder. If however, your child is less than 5 years old and he or she still wets the bed or still passes urine at otherwise inappropriate times, there’s no cause of concern as issues in bladder control are known to be a normal part of child development.
What Causes Bed Wetting?
There are many causes of bedwetting, especially among children. The causes can be classified according to the type of enuresis, whether it is voluntary or involuntary. Involuntary bedwetting is more common than voluntary and is often brought about by the following.
- An anatomically small bladder
- Hormonal problems such as insufficient antidiuretic hormone
- Neurogenic bladder
- Diabetes insipidus
- Obstruction of the urethral meatus
- Ectopic ureters
- Sleep disorder-associated breathing
- Major motor seizure
- Severe stress
- Persistent infections of the urinary tract
- Developmental delays that can interfere with the child’s ability to toilet train
On the other hand, voluntary enuresis can be brought about by the following.
- Behavioral disorders
- Emotional disorders like anxiety
- Extreme stress
- Familial tendency
- Forcing the child to toilet train when he or she is not yet developmentally ready
Experts say that voluntary enuresis is most often associated with psychiatric mental health problems such as oppositional defiant disorder characterized by disobedient, defiant, and negative behavior which is definitely worse than the usual “testing” behavior seen in children.
What Can Be Done?
The good thing about bedwetting is that it can be easily managed. The following are the most common treatments or therapies employed.
- Behavior modification – Three out of 4 children with enuresis respond exceptionally well with behavior modification. It is inexpensive and works on the principle of operant conditioning. Alarms are set off to awaken the child to go to the bathroom to urinate. Other behavior modification techniques can include withholding liquids a few hours before going to bed, physically waking up the child to urinate at night, teaching kids to retain urine, and giving kids positive reinforcement.
- Psychotherapy – This is often recommended for kids who are diagnosed with secondary or voluntary enuresis suggesting the role of psychosocial problems in the development of bedwetting.
- Pharmacotherapy – Imipramine and Desmopressin acetate are two of the most commonly used, and equally effective medications for enuresis. However, these also have a high relapse rate especially when stopped abruptly.
- Alternative therapy – Alternative healthcare practitioners find massage, acupuncture, and hypnosis to provide some form of remedy for certain kids who have bedwetting. However, since these do not constitute science-based practice, the results are somewhat inconclusive.
Bedwetting is a normal occurrence especially among kids who are younger than 5 years old. However, if the child is already older than 5 or has regressed to a time when he or she cannot control his or her bladder, then it becomes a problem.