Bedwetting in children (Enuresis)

What is enuresis?

Bed-wetting is a common occurrence till five years of age. As such we know children bed wet until that age thus this is understood as a developmental disorder: something that is part of growth and development which becomes a matter of worry if not attained at a specific age where it should have been attained. Statistics have shown that 95% of children are dry by day at 3 to 4 years and are dry by night latest by 4 to 5 years. Before that it should not be a matter of great alarm to the parents. It should be a cause for greater concern if the child has been dry by night in the past and starts bed wetting later; or if bladder control has never been attained by the child beyond the age of 6 years.

Clinical signs that point to enuresis

Enuretic children void urine into their clothes during the day or in their bed at night. The definition does not explain whether this is involuntary or intentional. A single occasional episode does not qualify as a problem. Most normal children can develop a sporadic episode of bedwetting if they have had some emotional trauma like experiencing an accident, watching a scary movie or even on hearing a story of something that frightened them. It is important to note whether the child has had an extra consumption of water or be a victim of other illnesses like diabetes, epilepsy or some spinal cord conditions.

Evaluation of a bedwetting child

Physical examination of the child is essential to rule out any medical condition that may transiently disrupt bladder control. Most commonly a urinary infection is responsible, in which the frequency of passing urine goes up and children are unable to control the urge as the sensation to pas urine becomes slightly dulled. Diabetes in children may be manifested by increased frequency of urination and may be clubbed with wetting which can be more at night. Children without any medical condition who bed wet may be stressed or upset or even frustrated and angry. Sibling rivalry may also express itself as a bed wetting behavior.
Such children may have:

  • Specific medical conditions that substantially raise their urine output during sleep
  • Slower than normal nervous system development leading to an inefficient bladder tone
  • Slow wave sleep abnormalities thus they have difficulty in waking from deep sleep
  • Habitual retention of urine thus leading to over filling of the bladder and enuresis
  • Genetically smaller bladder that has lesser capacity to hold urine and overflows often
  • Urinary infection which is a transient phenomenon and gets controlled once treated
  • Epileptic seizures that involve loss of bladder control during the tonic clonic convulsion
  • Emotional disturbances and turmoil which children cannot express openly to anyone

Outcome of bedwetting

Bed-wetting may lead to behavioral problems because of guilt and embarrassment the child feels. It lowers the self esteem and allows negative self perception coupled with anger from the family members and social stigmatization. These children are frequently teased by their peers and develop a sense puzzlement and humiliation. They themselves are unaware of why this is happening to them and the teasing and mocking worsens the situation by adding to anxiety, which further lowers the bladder tone. Many parents fail to understand the causes of bedwetting and offer punishment, which only worsens the situation.

How it gets OK

As is usually thought and is quite frequently true, children do outgrow bed wetting, but an evaluation is certainly warranted to prevent emotional scarring that may arise if the problem is left untreated too long. The child should realize that bed-wetting is not the child’s fault. Parents must understand that punishment is not the solution. Bed-wetting can be a medical or behavioral condition, which is correctable with behavior modification and medication when warranted. Star charting, reward system and bladder training techniques provided under supervision, can solve the problem and save the child from emotional turmoil which is likely due to embarrassment and low self esteem. At MINDFRAMES we offer a combination of medication (if required) and behavior therapy to deal with enuresis. Specialist referrals to evaluate for anatomical abnormalities, neurological and medical conditions is also offered when needed. Star charting and token economy help tackle the problem well in time and prevent the emotional turmoil which always accompanies enuresis.

Watch your behavior

Parents truly need to:

  • Encourage personal responsibility
  • Stay calm, patient and supportive
  • Let the child know that you care
  • See the impact it has on him/her
  • Are nonchalant but show concern

Things to avoid

It is important that parents:

  • Do not ridicule or mock the child
  • Do not let others tease the child
  • Do not retaliate back with anger
  • Do not let your anxieties show
  • Do not discuss in front of the child

What you can do

It is beneficial if parents:

  • Reduce fluid intake after 7 PM
  • Assure bathroom use before bed
  • Set a time for getting up at night
  • Assure easy access to the toilet

Frequently Asked Questions

My 6 year old started bed wetting after the birth of my daughter, why?
Your older one is expressing sibling rivalry. He is emotionally disturbed as he is no longer the center of attention and is bed wetting to get it.

Frequently Asked Questions

When my son bed wets at night he cries loudly in pain. Why is it so?
This bed wetting seems to be a urinary infection which may cause pain and hence screaming. Medical evaluation will point towards the cause of the problem and you can take steps to correct it.

Frequently Asked Questions

Is punishment appropriate to stop my 7 year old from bed wetting?
Punishment makes the situation worse, lowers confidence builds defiance. Behavior therapy, start charting, omission training, all under expert guidance are the best solution to this problem.