My child is bedwetting – I come because my child wets the bed for years! – the child does not want and does not want to get clean – I have already done so much, but my child just willfully, out of spite, wets the bed every night, sometimes even in the pants during the day, and he is already 10 years old.
Causes of bedwetting in children
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). This or similar are the statements of parents of bedwetting children and adolescents. What are the causes and the complex of questions behind bedwetting at night and during the day? Is the clinical picture a congenital condition or even a hereditary disease, a bladder condition or a nervous disorder? These and similar questions are also addressed by parents to the doctor. Bedwetting does not exist as a disease in its own right. It is always a symptom (sign) that can have many causes. The majority of bedwetting children are those who have neurosis due to disturbed relations with their environment. From the researches we know that neurosis can present itself in very different forms. Neurosis is considered to be all abnormal functions of individual organs or organ systems, which are controlled by the nervous system. They almost always arise from disturbed relationships of the person to his environment. Bedwetting, which sometimes occurs every night, sometimes every few nights or even only every few weeks, is the most common form of childhood neurosis. It is often very difficult to discover the physical or mental (psychological) event that has been incorrectly processed by the child and has now caused these disorders, because the child, of course, can not express himself as an adult.
Symptoms, complaints and signs
When children enuresis the complaints and symptoms are usually relatively clear. In this case, bedwetting occurs in childhood, which in most cases occurs during sleep and therefore at night. However, bedwetting can also occur during the day or in certain situations and have a very negative impact on the quality of life of the affected person. Often bedwetting in children is associated with psychological upsets or depression. Many of the children also suffer from bullying or teasing and thus also have difficulties in making friends and socializing. The child’s social life is also considerably restricted and made more difficult by bedwetting in children. The symptoms of this condition also depend greatly on the severity, so bedwetting can occur very frequently or only after a stressful and a busy day. The relationship with parents can also suffer from this disease, with many parents also suffering from psychological discomfort or depression as a result and needing psychological treatment. If there is no treatment for the disease, self-healing usually does not occur.
Social disorders in bedwetting children.
Bedwetting as a separate disease does not exist. It is always to be understood as a symptom (sign), which can have versatile causes. So what is the child’s coenvironment and environment? First and foremost the parents and the people who constantly interact with the child and represent the smallest environmental association, the family. Thus, in fact, one sees a very considerable percentage of bedwetting children coming from disturbed family relationships, in which the child does not receive the necessary security and attention. The disturbances in the relations between mother and child are very much in the foreground, because the bonds with the mother are usually the deepest. Nervous overstimulation, overload, unsteadiness in the mother’s nature diminish the understanding for the child. But also defiant rejection of the child towards the strict father and similar phenomena must be considered as causes of disturbed relations. Moreover, children often give us credible information without being pressed with suggestive or specialized questions. For example, bedwetting children occasionally report during playtime and other child-oriented activities: “Nobody likes me. – Mother only loves my sister.- I am so afraid of being hit.” If one gets to the bottom of these statements during a consultation with the parents, these expressions of the child inevitably fit into the overall picture. A thorough discussion with the parents and also an observation of the child, combined with discussions with him, not only help to clarify the complex of causes for the occurrence of bedwetting, but also represent a very essential part of the treatment.
Treatment of bedwetting in children
Learning to clean the bed is done by means of a conditional reflex, i.e. the child is put on the potty or toilet at very regular times (and this is very essential), and the stimulus to empty the bladder is further supported by the request to “make A-A” and the like. The child must first learn to empty the bladder at will and also to feel the fullness of the bladder in the first place and then to control it. That is why it is necessary to bring the child to the bladder emptying at certain times and it is equally important to keep the situation as constant as possible, i.e. it is not good to let the child urinate once here, once there. For example, if a child is used to standing on a carpet with his potty, the fact that he occasionally has to put the soles of his feet on the cold floor can already cause irregularities if the natural course of things is already disturbed. The same applies to the shape of the potty with a wide or narrow rim and similar factors, because a conditional reflex must be honed in under the same external conditions. Praise for accomplished performance has a spurring effect on a normally developed child while one should be more restrained with reprimand about the wet panties or the wet bed the younger the child is.
Best time to urinate independently
Bedwetting, which has a neurotic basis, not infrequently sets in after a period when the child was already clean in bed. For example, the third and fourth years of life represent a particular point of danger, because at this stage of development, when environmental disturbances occur, a disturbance in the already existing conditional-reflective activities is also more likely to occur than in the quiet childhood phases. If experiences occur, which disturb the relations of the child to the social environment, and negative reflexes are trained, the conditional-reflective (neurotic) bedwetting can appear. The 13th to 24th month is particularly suitable for learning conditional-reflector bladder activity. It is not uncommon to see delayed dryness in children whose cleanliness education was in the hands of several or even many people. As we will understand from the foregoing, it is not only important that the child is dehydrated, but how this is done. If the education in cleanliness was missed, mainly due to external reasons, then a bedwetting arises, which is much more difficult to treat, because now it is necessary to teach the older child, in whom the wetting occurs habitually, the bladder regulation activities, without the child having already possessed a so-called organ feeling (i.e. fullness of the bladder, urge to urinate). The difficulty also lies in the fact that the child who has not yet become clean is considered to have bladder problems and is taken to the doctor. And in fact, in these children, not at all rare – but depending on the duration of constant bedwetting – bladder muscle weaknesses are found, because they had not yet learned to use these muscles at all.
Bedwetting while sleeping
Very often, the child’s deep sleep is blamed as the sole cause of bedwetting. Very often, the child’s deep sleep is attributed as the sole cause of bedwetting. It is well known that a healthy child sleeps deeply after a cheerful and exuberant, but also well-balanced day, while a child who is physically and psychologically disturbed for various reasons sleeps restlessly. It is the same with the children afflicted with difficult experiences. On the basis of researches we know that the brain of the human being and also of the child does not sleep evenly, but that so-called guard points (better guard points), which are formed in the cerebral cortex around the 2nd year of life, keep watch over the maintenance of vital functions, and thus make the urge to urinate conscious. Accordingly, the reflection causes the awakening when the bladder is full.In bedwetting, a weakening of the waking functions plays a significant role. Deep sleep is not the cause of bedwetting, but a reduction of the waking functions in the brain due to a neurotic inhibition process. Therefore, we do not consider it justified to pull bedwetting children out of sleep several times. Taking a child under the age of two out again at night is without harm, because the waking functions are not yet properly developed. If bedwetting children are awakened too often at night, and unfortunately often very drastically, they become restless, anxious and insecure, and in the evening they already go to bed fearfully, they also sleep correspondingly restlessly, and in restless sleep bedwetting happens more often than in calm, balanced sleep. Usually these children are also quiet and withdrawn during the day, sad and tired, because they have not been able to find the necessary rest and refreshment due to the interrupted sleep.
When should you go to the doctor?
Bedwetting in children occurs so frequently that it is not generally an occurrence, which must be immediately clarified by a doctor. Especially when young children have just become dry or the first nights without a diaper are approaching, occasional bedwetting is the rule rather than the exception. Even children who are basically already reliably dry can have relapses. These can simply occur for no particular reason. Sometimes, however, they are also associated with infections, particular physical stress or even special life circumstances. For example, many parents know the phenomenon that with the birth of a second child, the bedwetting of the first also starts again. Sometimes this happens unconsciously, but it can also be used deliberately to draw the parents’ attention to themselves. So often behind it is also a childish overload with a certain situation. If this subsides after a few days and appropriate discussions and a lot of attention, a doctor does not necessarily have to be consulted. However, if the bedwetting persists for many days, a pediatrician should be consulted. This also applies if bedwetting suddenly starts in older children who have long since left the diaper behind. Going to the doctor is also advisable if unusual neurological symptoms appear, such as unsteadiness of gait, slurred speech, etc. The pediatrician is generally the first point of contact for wetting children, and can refer further to specialists if necessary.
Treatment and therapy of bedwetting in children.
In neurotic bedwetting, psychotherapeutic measures of various kinds are the main focus of treatment. General-educational measures, which are mainly based on praise and recognition and give the child the necessary security, significantly support the medical measures. In particular, it should be pointed out that it is completely wrong if the child is repeatedly made out to be a bed-wetter and degraded on all possible occasions. Whether additional drug treatment is necessary will depend on the individual case. Withdrawal of fluids in the evening has at most the meaning for bedwetting that one tells the child: “You have now drunk little or nothing at all and will therefore not need to wet the bed.” – i.e., a suggestive effect, but not a physiologically based one. This means that one should not cruelly torment the child with thirst suffering, because experience teaches that even thirsty children wet the bed, precisely because this phenomenon, simply speaking, depends much less on the kidneys and much more on the brain. There is no general and universal prescription for such a multifaceted manifestation as bedwetting in childhood. Individually adapted treatment measures, which the doctor can advise, of course taking into account the social context, are required.
Outlook and prognosis
Bedwetting in children is considered a natural course of the development and growth process. This process has a very good prognosis, as complete recovery occurs in almost all cases. The exception is patients with diseases of the urinary tract, musculature or other deficits. Under normal circumstances, every child experiences bedwetting. The activity of the sphincter muscles must be learned, as it is not an innate ability. The duration of the learning process is individual and can last weeks, months or years.Children who have already learned not to wet the bed at night can also experience a relapse. Stress, changes in living conditions or illnesses very often lead to renewed bedwetting. Moreover, this can also occur in adulthood. With rest, patience and a good regulation of the amount of liquid, a renewed relief and later healing of the symptoms is achieved. It is helpful to go to the toilet right before bedtime and to drink a small amount of fluids just before going to bed. In the learning process, the child can be woken up again at night for some time to prevent wetting. This is a temporary measure, as with sufficient training and control over the sphincter muscle, bedwetting will cease.
Aftercare
Follow-up care seems appropriate only if bedwetting recurs after it has subsided for months or is still present after the age of five. Toddlers urinating in bed at night is not uncommon. They first have to learn to control their bladder. A good third of all boys and girls are unable to sleep dry in their fourth and fifth year. After that, their number decreases sharply, statistically speaking. If bedwetting disappears in children, it is unlikely to recur. Follow-up care is then not necessary. If, on the other hand, the symptoms reappear after they have subsided for a longer period of time, follow-up care is necessary. A consultation with the doctor clarifies the situation. Possible causes can be analyzed. It is not uncommon for stress or problems to cause bedwetting. One of the main tasks of aftercare is to prevent possible complications. However, these are generally minor in the case of bedwetting. Contrary to what many people think, nocturnal voiding is not an abnormal condition. It can be countered in everyday life with suitable pads and bedding. Rather, the goal of follow-up care is to provide information about practical tips and to create a relaxed atmosphere for the child. Parents can, for example, install reward systems or an electronic wake-up system. Sometimes, temporary medications also help.
