How Does Bedwetting Occur?
Bedwetting refers to the continued difficulty of a child, over the age of six years old, to control their bladder functioning during the night-time. Most children follow the sequence of developing bowel control by day first, then by night, followed by bladder control by day and then by night. Daytime wetting is called “diurnal enuresis” and wetting during the night “nocturnal enuresis”. It is extremely common among children who are under the age of six to wet the bed but children are labelled “enuretic” when it doesn’t go away at the expected time. Although boys are twice as likely as girls to wet the bed at night, daytime frequency of urination and wetting tend to be more common in girls. The prevalence of enuresis declines as the child matures.
Enuresis can be either primary or secondary. “Primary enuresis” exists when a child has never achieved consistent dryness for at least a year or more. Most nocturnal enuresis in children is primary enuresis. For most of the bedwetters who have never achieved night-time dryness, the most likely reason for bedwetting is a developmental delay. “Becoming dry” is a natural developmental process like walking, talking etc. and is determined by the child’s readiness both physically and psychologically. Bedwetting also often runs in families. If both parents wet the bed when they were young, it is very likely that their child will do so as well.
“Secondary enuresis” describes a child who has achieved dryness for at least a year and subsequently loses bladder control. This may be due to some external stress that the child is experiencing. For example, the birth of a new baby, moving house or parental separation can cause setbacks in normal development and result in bedwetting. From a developmental perspective, the skill that the child has most recently learned is the one that is most vulnerable to relapse if the child is under added stress. This is usually temporary and goes away once the stress has been resolved. Physical causes of enuresis such as a urinary tract infection may also account for the child’s difficulties but are rare.
What can help a parent who child is regularly bedwetting?
If your child is over the age of 5 years and has daytime and night-time wetting, then the first step would be a doctor’s examination to check for any physical cause. Your G.P may check for signs of a urinary tract infection, constipation, bladder problems or severe stress.
Be patient & reassure the child:
It is a good idea to reassure your child that bedwetting is a normal part of growing up and that it’s not going to last forever. It may help your child to hear about other family members who had similar problems when they were young. Do not punish, scold or pressure your child as this will make them feel more anxious, discouraged and incompetent and make the bedwetting problem worse. Be optimistic with your child about their ability to eventually control their wetting.
Limit the amount of fluid in the evening:
Sometimes it can help to reduce the amount of fluid that the child takes after their evening meal.
Set up & promote good toilet habits:
Setting up a regular routine for going to the toilet can also help. For example, encouraging the child to go to the bathroom first thing in the morning, after each meal and immediately prior to bed-time to prevent accidents from happening. Praise your child for remembering to go to the toilet on his own during the day or night.
Use logical consequences and promote the child’s responsibility:
When your child wakes up with wet sheets, involve your child in helping you to change the sheets. Explain to the child that this is not a punishment but is part of the process. They may actually feel better knowing that they helped out. For older children, you could leave out extra sheets or towels and show them how to change the sheets themselves. This can help the child to take responsibility for their behaviour but also minimises the amount of parental attention, which they get for their behaviour.
Use a reward system:
Set up a star chart with your child, giving them a star, plus lots of praise and encouragement each time they achieve a dry night. At the end of a short period of time, the number of stars that the child has earned could be traded in for a tangible reward, such as going to the park, staying up later one night etc. Remember to give your child lots of praise and encouragement for each of their successes.
Identify & reduce stress:
If your child has been dry for a period of time and then suddenly starts to wet again, check to see if there has been a stressful event that may have caused the wetting behaviour. If there has been, try to deal with the stressful event as best as you can. This may involve talking to the child about their feelings, giving them some extra support or playtime. Once the stressor has been resolved the wetting usually disappears.
Alarms, such as Wetstop, Nytone and Night Trainer, can help older children to learn to stay dry at night. In order for this approach to work however your child needs to be interested and motivated. The child wears a small, lightweight battery operated buzzer attached to his pyjamas and the alarm goes off at the first tiny drop of urine. The child must then wake up, stop urinating and go to the bathroom to finish. Within a few months the child learns to wake up to the feeling of a full bladder and can then go to the toilet on their own.
Should you require any further assistance with the management of issues of parenting or unusual behaviour in your children, please schedule an appointment with one of our Psychologists.