Bedwetting, enuresis or enuresis are terms for a childhood disorder in which children and adolescents do not yet have the natural urge to urinate under control. In most cases, this causes them to wet the bed at night without realizing it. Bedwetting can have both psychological and physical (hormonal balance) causes and should be examined and treated by a pediatrician. Under no circumstances should children be punished for bedwetting, as this usually only worsens the condition. Parents, child and doctor should work together against bedwetting.
What is bedwetting?
Learning to clean the bed happens by means of a conditional reflex, that is, the child is put on the potty or toilet at very regular times (and this is very essential). Pathological bedwetting, enuresis or wetting the bed is said to occur when a child of five years of age or older wets the bed regularly during the day or at night. The duration of the wetting varies from case to case. In about one percent of those affected, the problem persists into adulthood. In this condition, a distinction is made between primary bedwetting and secondary bedwetting. Primary bedwetting is when a child has never been dry for a long period of time since birth. If there have already been dry phases of at least six months and the child wets the bed again afterwards, this is called secondary bedwetting. However, primary bedwetting is much more common.
Causes
The specific causes of primary bedwetting are not clearly understood. Several factors probably play a role, although psychological problems are hardly significant in this form. Experts agree that primary bedwetting is a developmental delay of the child. The affected children do not sense when their bladder is full. The control mechanisms that govern bladder emptying have yet to be fully developed. It is also possible that this form of bedwetting is inherited, as there are families in which this problem is common. Some research results show that in many enuresis patients the hormone vasopressin is insufficiently produced. This hormone controls the water balance in the body. If it is sufficiently present, less urine is produced at night, so there is little or no need to go to the bathroom at night. The main causes of secondary bedwetting are usually emotional problems or sudden changes in the child’s environment. For example, bedwetting is particularly common in the event of the loss of a family member, parental separation or an impending spatial change.
Symptoms, complaints and signs
Bedwetting is expressed mainly by the involuntary discharge of urine (usually while sleeping in bed). This symptom has a disease value only conditionally. For example, it is normal for children to wet the bed until about the third or fourth year. Even later, this can still occur occasionally. Primary enuresis is the term used when prolonged bedwetting is considered a developmental disorder. The symptoms here are bedwetting, deep sleep and polyuria. Diagnostically, abnormalities regarding the hormone ADH and possibly accompanying psychological symptoms can also be identified. Those affected notice their bedwetting the next morning at the latest. However, it can also happen that those affected wake up as a result. The definition of enuresis serves to distinguish it from mild continence disorders: it is characterized by the complete loss of bladder contents, whereas incontinence can also mean the loss of no urine. Secondary enuresis, on the other hand, means that involuntary urination occurs at the earliest after a dry phase lasting six months. This is also often accompanied by psychiatric symptoms, the frequent desire to prevent urination (squeezing the legs and similar behavior) and a disturbed bladder emptying pattern. In addition, situational incontinence occurs in this context – for example, when laughing or coughing.
Course and prevention
The causes of bedwetting make it clear that a child does not intentionally wet the bed. In most cases, those affected are even highly motivated to get rid of bedwetting quickly and permanently. Therefore, parents must not blame themselves or the child under any circumstances. Punishments should also be avoided, as they put additional pressure on the child. Rather, a reward helps with every dry night.It has proven successful that the child records in a calendar over at least two weeks whether it was dry (sun) or wet (cloud). This measure alone often leads to success, as the children gain self-confidence and thus stop wetting the bed. In addition, care should be taken to ensure that the child does not consume large amounts of liquid before falling asleep. Drinks containing caffeine in particular stimulate urine production and promote bedwetting. If the child still wets the bed despite a lot of patience and good encouragement, an experienced specialist should be consulted. He knows best which individual treatment is most suitable for a child. If a child is wetting the bed due to psychological problems (secondary bedwetting), these should be managed as quickly as possible.
Complications
Bedwetting often leads to social complications. Children suffering from enuresis nocturna are often unable to stay overnight with other children. They are also often at a disadvantage on school trips. In some cases, the children or parents avoid such occasions, which can affect the child’s social status within the group. Even if the child participates in such sleepovers, bedwetting is often associated with shame and feelings of guilt. It is often accompanied by anxiety and dejection, even depression. Depression can fully develop in childhood. The clinical picture is characterized by depressive mood and loss of joy and interest. Other psychological problems such as hyperactivity are also possible. It depends on the individual case whether bedwetting is the cause, consequence or concomitant of another mental illness. In the case of enuresis diurna, the social complications are often the greatest. Accordingly, the psychological burden on the child increases if he or she also wets during the day. In addition, psychologically induced bedwetting occurs more frequently in children who suffer from abuse or neglect. This can result in further complications, for example post-traumatic stress disorder (PTSD), behavioral problems, and anxiety, obsessive-compulsive, and eating disorders. Complications that arise from treatment are very rare. Compassionate doctors and therapists can often help children overcome feelings of shame.
When should you see a doctor?
If a child occasionally wets the bed, this may have completely harmless triggers, such as very deep sleep. A visit to the doctor is then dispensable. However, if this behavior occurs more often, the causes should be clarified by a doctor. In any case, a doctor should be consulted if bedwetting occurs together with other symptoms. In particular, if the child complains of pain when urinating or a frequent urge to urinate, a urinary tract infection is suspected. If children wet themselves during the day, the reason is often a bladder dysfunction that needs medical treatment. Signs of urinary incontinence include constant clenching of the legs, loss of urine when laughing or coughing, and very frequent urination while drinking normally. If there is blood in the urine or the child complains of severe pain, the nearest hospital should be visited immediately. In these cases, the symptoms may be those of a severe bladder or kidney infection. A visit to the doctor is also advisable if the child was already dry and starts wetting the bed again after a longer period of time. Unless physical causes for bedwetting can be identified, a child psychologist should be consulted in addition to a physician.
Treatment and therapy
For the treatment of primary bedwetting, there are basically 3 approaches with the goal of completely and permanently eliminating bedwetting. Above all, child psychologists recommend behavioral therapy. Among other things, the children’s drinking behavior should be recorded and reflected upon. Since bedwetting is usually due to a developmental delay, the patient should also learn to take control of his or her own bladder through targeted bladder training. Alternatively, a device-based conditioning treatment is recommended, for example with the help of bell pants. The aim of this measure is to wake the child with a loud tone as soon as he or she wets the bladder. The child should learn to pay attention to the signals of the bladder even during sleep and thus avoid bedwetting. Another option for treating bedwetting is drug therapy.Here, the child is administered a synthetically produced drug that mimics the body’s own hormone vasopressin. This reduces the formation of urine during the night for about 8 hours. In any case, the measures for the treatment of bedwetting should be determined together with a pediatrician, so that they are also successful.
Outlook and prognosis
The prospects for a complete cure are normally very good in the case of bedwetting. In most cases, infantile bedwetting is a temporary phenomenon. Children experience bedwetting during the day or at night. Usually, the condition lasts for several months. Stress, restlessness, anxiety or a change in life circumstances lead to an increase in the symptoms. If the psychological factors can be clarified, relief occurs. Moreover, with sufficient rest and patience, children learn to use their sphincter muscle correctly. This usually leads to a spontaneous healing that lasts permanently. However, if a relapse occurs in exceptional situations, it is rarely of long duration. In some patients, enuresis occurs in adulthood. There may be physical problems or diseases that are easily treatable by a doctor. If the cause is a psychological disorder, healing may take some time. Nevertheless, there are very good prospects of recovery in this case as well. Recovery is less optimistic for people of advanced age. The older a patient is, the more likely it is that his or her sphincter will no longer function as usual. Despite treatment or therapy, bedwetting persists in a large number of patients until the end of life.
Follow-up
Bedwetting usually disappears on its own. Statistically, a good 30 percent of all 5-year-olds still empty their bladders at night. With increasing age, their number decreases significantly. A good one percent of adults are affected. Contrary to what some people think, enuresis is not a bad condition. Follow-up care is aimed at learning how to deal with it properly. The typical symptoms can reappear after they have disappeared for a long time. However, this so-called secondary enuresis occurs comparatively rarely. Once bedwetting has subsided, it is unlikely to recur. A doctor usually prescribes psychological therapy after the age of five. Behavioral and problem analysis have proven to be suitable. Restraint training can promote success. Stress and sleep disturbances are considered the most important triggers. There are also drugs on the market that are supposed to reduce the urge to urinate. However, their success is controversial. If bedwetting recurs from time to time without finally stopping, those affected can relieve themselves. Washable blankets, diapers, pads and other items make life much easier. Enuresis does not lead to further complications. It does not reduce life span, nor does it represent a serious disease.
What you can do yourself
Bedwetting can have a wide variety of causes, and treatment steps can vary accordingly. Bedwetting as a result of alcohol consumption, a nightmare or stress, for example, can be counteracted by changing lifestyle habits and sometimes also by changing the environment. Talking to a therapist can help identify the underlying cause and address it quickly. If bedwetting is caused by a medical condition or by medication, the first step should be to talk to the doctor in charge. In most cases, the nocturnal mishaps can be reduced or dealt with more easily by changing the medication or by taking appropriate preventive measures (dietary measures, electronic wake-up systems, incontinence underwear, etc.). For bedwetting in childhood, understanding and preventive measures are recommended above all. For example, a night light or an easily accessible light switch in the hallway or toilet can help the child reach the toilet. A bedside potty near the bed can also reduce bedwetting. Accompanying this, protective covers and keeping fresh bedding on hand will help. Parents should also allow enough time in the morning for the child to groom himself thoroughly after a mishap. The general rule is to talk to the child and communicate that bedwetting is not unusual and will go away on its own.
