Bedwetting is involuntary discharge of urine during sleep. We speak of bedwetting as a child of five years or more can't stop peeing at night at least twice a week. A child doesn't wet his bed intentionally and it isn't the result of drinking plenty or deep sleeping. Urinating during sleep is a common condition and treatment is often complex.
Cause
There is usually no clear cause for bedwetting. During sleep, some children (and adults) don't feel when their bladder is full. Therefore, they don’t wake up to urinate. Sleeping too deep or drinking too much during the day plays no role in causing bedwetting. A physical cause can rarely be found.
The following reasons may have to do with bedwetting:
- High urine production. The human body produces the substance ADH, which influences the production of urine by the kidneys. Normally, the production of urine at night is less than during daytime. Children who wet their bed, probably produce less of this substance at night than others. Why this is so, is not known.
- In some families, bedwetting is more common than in others. Therefore, there may be a hereditary factor for the development of bedwetting.
- Some people respond at night insufficiently to the signal that the bladder is full, but this has nothing to do with the depth of the sleep. Recent research demonstrates that children who wet their bed have a high threshold for waking up, making them difficult to wake up. That is why children don't wake up from the signal of a full bladder.
- Very occasionally (in one to two percent of the cases) there is a physical cause for bedwetting, such as a bladder infection or another bladder defect.
Symptoms
Bedwetting can be a big problem. In the first place, of course, for the bed-wetter him- or herself. He or she can be very uncertain and may get a negative self-image. Especially when family reacts negatively to the urinary problems. Additionally, bedwetting can have an adverse effect on social life. The older the bedwetter, the more this aspect outweighs.
Diagnosis
The diagnosis is made upon the story that the bed is regularly wet at night. In order to exclude the small risk of a physical cause, urinalysis is sometimes performed.
Treatment
Bedwetting eventually stops on its own in most cases. If it doesn’t, there are several ways to deal with the condition. No method, however, provides one hundred percent chance of success. It’s always important to stick to a selected method, or a combination of methods, for a number of weeks:
- Waking. Wake the child one time each night in order to pee. For example, before the parents go to bed. This method only works if the child is well awake and is aware that he or she pees.
- Calendar and motivation method. Every dry night is tracked on the calendar, for example with a sticker. After a pre-arranged result, the child gets a small reward.
- Bedwetting alarm. The first drops of urine are signalled by special panties and the alarm goes off. The child will wake up and go to the toilet to pee. The bedwetting alarm is available via the general practitioner, school nurse or home care association. The bedwetting alarm can be used from the age of six or seven years.
- Older children may follow an intensive dry bed training.
- Medication may play an important role in the process of finally being dry. They are sometimes used to help the child get rid of the problems for several months, as the first step of treatment to be permanently dry. In addition, drugs can be used to temporarely redeem a child (for example during holidays or sleepovers) from bedwetting. The advantage of drugs is that the effect is quickly visible. From the first night on, result can be expected.
Prognosis
Bedwetting may return, in spite of successful treatment. If this is the case, the same treatment can be started over again. Yet there will always be children who continue to wet their bed.
Considerations
- Always let the the child try to pee before going to bed. If it doesn’t, that’s okay. The point is that the child gets the chance to relax on the toilet for a moment.
- Explain on a quiet moment once again that it is the intention that the bed stays dry.
- Penalties do not make sense, but don’t say that it’s all right.
- Praise the child when it remained dry overnight.
- Give the child attention, apart from the bedwetting. For example, read a bedtime story each evening.
- If the child had a dry diaper during a few nights, it can be allowed to sleep without a diaper. So the child will notice more quickly when it pees. Put a plastic cover under the sheet to protect the mattress.
- Let the child take its own responsibility for the consequences of bedwetting. For example, let it clean the bed (or help with cleaning) as soon as it is able to do so.
- The child should feel free to drink as it wants to. Drinking does not affect bedwetting.
Facts
- The word nocturnal means ‘night’. The term ‘enuresis’ is derived from the Greek word enoureō (I water in, water against).
- In boys aged 4 to 7 years, the prevalence of bedwetting is approximately 12%, in girls it’s about 8%. In children aged 13 to 16 years, the prevalence is 1.5%. Among adolescents and adults, the prevalence is about 0.5%.
- Bedwetting is more common in boys than in girls and the condition continues longer in boys.