All about Bedwetting

How to Stop Bedwetting? Learn All about Bedwetting (Enuresis): A guide for the perplexed parent

If your child wakes up in the morning, soaked in urine, and you stand helpless and frustrated, this article is designed for you. Everything you wished to know and didn’t know whom to ask. This guide includes information on the causes for bedwetting and better ways to cope with the problem. We will cover many of the FAQs, discuss some commonly held myths and misconceptions about bedwetting, and provide information on the various treatments that are available.

Definition

Enuresis, the clinical term for bedwetting, is defined as involuntary urination after ages four to five and may be either nocturnal, diurnal, or both. An enuretic is an individual who persists in daytime or nighttime wetting past an early age. There is a distinction in the literature between Primary Enuresis, a child who has never stopped bedwetting or was dry for only a short period of time, and Secondary Enuresis, a child that was dry for at least six months and relapsed.

Prevalence

Enuresis is one of the most prevalent and frustrating disorders of childhood. A child is expected to sleep through the night without wetting the bed between the ages of two and four. However, at age four, 25% of children still wet the bed; at age five, 20%; at age six, 15%; at age ten, 8%; at age fourteen, 4%; and at age eighteen and over, 2% of the population are still bedwetters.

The Gender Factor

Bedwetting is more common among males than females; approximately two-thirds of enuretics are males, while one-third are females. As the age progresses, the proportion changes and is gradually equal in adolescence. Among individuals ages seventeen and up, two-thirds of enuretics are females, while one-third are males.
Some of the possible explanations for this gender difference is that girls mature faster than boys in early ages, while boys close this gap in later ages. No explanation was found for the higher proportion of females in older ages (seventeen and up). It is possible that in those ages we might find more emotional factors that affect bedwetting in females compared with males.

The Genetic Factor

There is overall agreement among researchers that bedwetting has a clear hereditary element. Among parents of children with bedwetting who came to our clinics, 75% reported that one or both parents or siblings wet the bed in childhood. When we examine the second genetic circle (grandparents, uncles of first degree, nephews), we find that more than 90% have a history of bedwetting.
One shouldn’t conclude, however, that this genetic factor indicates the existence of a medical problem. Bedwetting is characterized by being unable to recognize the signal that is being sent from the filled bladder to the brain during sleep. As a result, instead of contracting the sphincter muscle, the child relaxes the bladder and starts to urinate. This may be corrected by learning preventive measures.
Occasionally, I’m asked by parents, “If there is a genetic factor, how can treatment help?” My answer is that there is no relationship between the genetic factor and the treatment’s chances of success. The purpose of the treatment is to correct the malfunction in the reflex system.
Some parents who had bedwetting problems until adolescence and outgrew the issue with no treatment avoid seeking treatment for their enuretic child. They assume that when the child reaches adolescence, the child will also outgrow bedwetting. There is no basis for this assumption; unfortunately, there is no guarantee that a child will stop wetting the bed with no treatment. Moreover, even if the parents could be assured that the child will outgrow bedwetting at adolescence, there is no justification to let the child suffer from bedwetting during childhood. Bedwetting affects a child’s quality of life, and timely treatment improves the quality of life.

The Causes of Bedwetting

The conventional train of thought among both parents and many pediatricians is that bedwetting is a medical or psychological problem. Often, the patient undergoes a comprehensive and unnecessary medical assessment with no findings. However, a medical, neurological, or urological problem is only the primary diagnosis among 1% of enuretics. A psychological cause, such as family problems, social adjustment, or fears, is a factor among an additional 10% of patients.
In fact, the majority of enuretics (90%) do not have either anatomical or psychological problems. For most enuretics, the primary source of the issue is unusually deep sleep. These are normal, healthy children who have not learned to activate the appropriate reflex system during sleep. Typically, when a person sleeps and pressure is built up inside the bladder, a signal is sent to the brain. Among enuretics, the signal is not recognized by the subconscious reflex system and instead of contracting the sphincter muscle, which is the circular muscle that keeps the bladder closed, the child relaxes the muscle and urinates during sleep.

Depth of Sleep

Among parents of enuretics, 97% report that their child is an unusually deep sleeper (based on a study with 30,000 parents). Parents describe attempts to walk their child to the bathroom during the night akin to dragging a sack of potatoes. They report that their child is disoriented, does not sense being taken, and in the morning has no recollection of the event.

Dribbling

Among enuretics, some individuals who suffer from involuntary drops of urine will discharge during the day. This typically happens in children ages four to eight.
Dribbling generally happens when the child is busy in an activity that requires mental concentration (e.g., watching TV, playing computer games). The child does not recognize the signal from the bladder, relaxes the sphincter muscle, starts to urinate, and stops immediately by contracting the sphincter muscle. The consequences of this behavior are the constant wet spots on the child’s clothes.

Dribbling During Sleep

Many parents of young children are familiar with the dribbling problem – when involuntary drops of urine will discharge during the day. This typically happens in children age four to eight. This problem is relatively easy to treat through specific exercises combined with Cognitive Behavioral treatment, helping the child to recognize signals from the filled bladder traveling to the brain and to respond accordingly.
A less familiar problem is dribbling during sleep. The child does not recognize the signal from the bladder, relaxes the sphincter muscle, starts to urinate, and stops immediately by contracting the sphincter muscle. The consequences of this behavior are the wet spot on the child’s clothes which generally doesn’t reach the sheet.
On one hand, this is a good sign, since the child corrects himself by stopping the flow of urination; it means that his subconscious restraint mechanism during sleep is partially functioning. From a learning point of view, this is a much more advanced condition compared to a child who wets himself completely (which means that the child has no learned skills). Having said that, from an Enuresis specialist point of view, this is one of the most difficult conditions for bedwetting treatment. In those cases, treatment with a bedwetting alarm is useless since the very small amount of urine will not activate the alarm. The specialist has to be very creative and to consider different approaches which will be suitable for such cases. From my experience, the treatment for this child takes longer than the usual treatment. Sounding counter-intuitive, the easiest cases to deal with are of children that wet completely every night.

Understanding the Enuretic child

Knowing the causes of bedwetting is not enough. It is essential that parents understand what it is like to be a child with a bedwetting problem and understand how to stop bedwetting in an effective way. Since it is a genetic issue, many parents have suffered from bedwetting themselves. Even this is not enough preparation to deal with their child’s issue.
What is going in an enuretic child’s mind? The following story will illustrate the typical situation.
I received a phone call from an ex-patient who is twenty-five years old. He told me that when he was nine years old he came with his parents to my bedwetting clinic. His parents accused him of not trying hard enough to deal with the problem, and then he reminded me of my response to his parents: “What do you want from him? Why do you blame him? He does not wet the bed on purpose; he doesn’t feel when he is wetting the bed.” The young man said, “For the first time in my life, I felt that someone understood me.” Although many years had passed since this meeting, he remembered every single detail from this session and was so grateful. By the way, he outgrew bedwetting after only three months of treatment.
If parents will realize what is going on in their child’s mind, they will certainly act differently by showing understanding, sensitivity, empathy, and support.

Bedwetting is Treatable

For both parents and children, bedwetting can seem like an incurable problem. Children may feel humiliated or defeated. They may not be able to participate in normal activities, such as visits away from home or sleep-away camp. In extreme cases, enuresis can be seen as an obstacle among young adults who are interested in dating and marriage.
It is important to know that bedwetting is treatable. This is not an insurmountable obstacle; rather, with some time and care, you will be able to find the appropriate treatment method for your child. Most important is to believe in your child and build their self-confidence on the way. Nothing can more easily demonstrate the great relief former enuretics feel when they defeat this problem than their own words:
M. female, age sixteen, treated with her sisters ages fourteen and eight, wrote:
I find no words to describe my joy…(I have) stopped bedwetting and today I wake up completely dry. This is a wonderful feeling. To all the boys and girls who read my letter, listen to me, don’t give up. Believe in yourselves. I believed and succeeded. You should try too. You will see that one day you will stop bedwetting and it will be great. I wish with all my heart that soon you will wake up clean and dry. Believe me, it is wonderful.
N. female, age eleven wrote:
Neither you nor anyone else can imagine how happy I am that I stopped bedwetting. It isn’t easy for me to express myself … Finally, I can say, I did it.… Before the treatment I couldn’t sleep away from home. My younger sister ceased bedwetting before me and it really upset me. Finally, this is the most wonderful thing that happened in my life.

Does the removal of enlarged adenoid and polyps help stop bedwetting?

Some children who suffer from bedwetting have enlarged adenoid and polyps. Sometimes the removal of the enlarged polyp will cause the child to stop bedwetting. One shouldn’t jump to the wrong conclusion that enlarged adenoid and polyps are the cause for bedwetting. Many bedwetters do not have enlarged polyps and many children with enlarged polyps children do not have a bedwetting problem.

So what is the relationship between bedwetting and enlarged adenoid and polyps? Enlarged adenoid and polyps are contributor factors in the causes for bedwetting since the airflow (Oxygen) is disturbed and it affects the depth of sleep. It is very similar to obesity which also affects the airflow. Sometimes, the adenoid’s removal leads to dryness at night. However, in most cases it doesn’t solve the problem.