What is Bedwetting?
The medical name for not being able to control urination is Enuresis (pronounced: en-yuh-ree-sis). It is sometimes also called involuntary urination. Nocturnal enuresis is involuntary urination that occurs at night, usually while the childis sleeping.
There are two kinds: Primary and Secondary. Primary is bedwetting that has occurred since infancy. Secondary develops at least 6 months, or even several years, after the child has learned to control their bladder.
The bladder is a muscular receptacle that expands as urine enters and contractsto push the urine out. In normal bladder control, nerves in the bladder wall send a message to the brain when the bladder is full; the brain then sends amessage back to the bladder to keep it from automatically emptying until the person is ready to go to the bathroom. However, in children with nocturnal enuresis this process is interrupted causing them to urinate involuntarily at whilesleeping.
What causes Bedwetting?
- Medical causes. Medical conditions that can trigger secondary enuresis include diabetes, constipation, and urinary tract infections. Signs and symptoms of urinary tract infection vary depending on the child's age and on which part of the urinary tract is infected. In younger children and infants, the symptoms may be very general (i.e. irritability, poor feeding or vomiting). Sometimes the only symptom will be a fever that seems to appear for no reason and doesn't go away. In addition, if their urine is foul-smelling or looks cloudy or contains blood, it is possible they may have a urinary tract infection.
- Hormonal causes. A hormone called Antidiuretic hormone (ADH) helps the body to concentrate the urine at night, reducing the likelihood the bladder will fill during the night and allowing for uninterrupted sleep. However, some children don't make enough ADH, which means their bodies may produce too much urine while sleeping. This leaves the child with a full bladder during sleep and can lead to, without proper training, the child to wet the bed.
- Bladder size. In some children with enuresis, muscle spasms can prevent the bladder from holding a normal amount of urine. Some children also have relatively small bladders that can't hold a large volume of urine.
- Deep sleepers. Some children may sleep so deeply that they don't wake up when they need to urinate.
- Psychological causes. Stress can be associated with enuresis. It's not uncommon to feel stressed out during the child or teenage years, and things such as divorce, the death of a family member, a move to a new town and adapting to a new school and social environment, bullying or not fitting in at school, or family tension can all feel overwhelming to a child.
- Medical causes. If your child is displaying any of the above medical identifiers take them to see your GP. They will determine if there is a medical cause to their bedwetting and treat it appropriately.
- Bladder training. This can be achieved by helping the child to expand their bladder during the day so it will hold more liquid when they’re sleeping. To do this have the child drink a large glass of water (juice or similar is also fine) and have the child tell you when they need to urinate. By getting them to hold off urinating for longer and longer periods you will help their bladder to increase its capacity. Start with small intervals (i.e. 2 minutes) and increase by 1-2 minutes each time. Use rewards like sweets and activities if necessary to encourage them to hold withoutwetting or using the toilet. Over successive days the child’s bladder will expand and they will reinforce using the sphincter muscles at the opening to the bladder. This will help if your child’s bedwetting is caused by Hormonal imbalance, bladder size or if they’re a deep sleeper.
- Before bed. You can take some basic steps to prevent your child having an overly full bladder during the night by decreasing the amount of fluids they drink right before bed and having them use the toilet before going to bed. It may help to avoid them eating certain foods in the evening: Foods that can irritate the bladder include chocolate and sodas or other carbonated beverages containing caffeine.
- Bedwetting alarms. Doctors and nurses sometimes prescribe bedwetting alarms to treat teens with enuresis. With these alarms, a bell or buzzer goes off when a person begins to wet the bed. Then, you can quickly turn the alarm off, go to the toilet, and go back to sleep without wetting the bed too much. Don't get discouraged if the alarm doesn't help to stop wetting the bed immediately, though. It can take many weeks for the child to be reconditioned for the new waking behaviour. Over time they will train themselves to wake before the alarm goes off or to hold your urine until morning.
People who sleep very deeply may need to rely on a parent or other family member to wake them up if they don't hear the alarm. The key to bedwetting alarms is waking up quickly; the sooner a person wakes up, the more effective the behaviour modification for telling the brain to wake up or send the bladder signals to hold the urine until the morning.
There are many more reasons why your child might be bedwetting. It could be they have stress in their life. Perhaps they are being bullied at school or kindergarten. Perhaps they're having difficulty fitting in socially. The only way to determine if there is an emotional cause to their bedwetting is to talk to them. Make some time to talk about their day, perhaps after dinner or before bed. Ask them to tell you what they did and who they spoke to. You can ask them to tell you about the people they like and the people they don’t like or about the activities they participated in and the things they liked and disliked about it.
Whatever the reason, be it medical, behavioural or emotional, it can be an embarrassing time of your child’s life. It is important to maintain an open line of communication with them. The more comfortable they are with discussing issues with you, the more quickly bedwetting can be resolved.