Bedwetting in children Causes and Treatment

Nocturnal enuresis is known to occur frequently in children. Most children wet their beds between 3 and 5 years of age after which the frequency reduces, and they stop doing so. Nocturnal Enuresis is diagnosed in children above the age of seven, when there is an involuntary release of urine during sleep, occurring two to three times a week for a period of at least three months. This is what is known as bedwetting meaning. 

Bedwetting can be a very stressful and embarrassing situation for the child and family due to which they even tend to avoid outdoor visits and sleepovers. Because of the emotional distress involved, it is necessary to support the child and help him/her manage the issue. It is important to understand the different types and causes of bedwetting in order to help the child overcome it. There are multiple physiological and psychological causes of bedwetting. 

Types of bedwetting

Understanding the types of bedwetting helps in planning for treatment. There are two types of nocturnal enuresis:

Primary: This occurs when the child has never been able to attain bladder control, i.e., bedwetting has been present since infancy. Usually, by 3 years, children are able to achieve daytime bladder control and after a year or so, night-time. However, in primary enuresis, night-time control is never achieved.

Secondary: This occurs when the child has achieved bladder control for more than 6 months but has started bedwetting again. This could be due to underlying medical conditions or psycho-social issues.

Causes of bedwetting:

Physical causes: Certain medical conditions like bladder infections, hormonal issues, constipation, etc can lead to bedwetting. Genetics also has a role to play as bedwetting is common in children whose parents had the issue themselves in their childhood.

Psychological causes: In some cases, bedwetting is caused by emotional reasons. Stressful situations can trigger bedwetting in a minority of children. Changes in the family environment, transition to a new place, the birth of a sibling, punitive parenting, etc., contribute to behavioural changes in the child which in turn has been linked to bedwetting. Traumatic events and even those which disrupt a child’s routine can cause enuresis.

Managing Bedwetting

Irrespective of the type, bedwetting tends to affect children emotionally. It leads to a loss of self-esteem, anxiety, guilt, embarrassment, and behavioural issues. Some parents wait for the issue to go away on its own, hoping for their child to outgrow the issue. However, waiting for the issue to resolve by itself is not a good idea as the child tends to suffer emotionally. It is thus essential to consider ways to overcome the issue.Here are some ways to supplement bedwetting treatment with some techniques that can be practised:

Medical evaluation: Since bedwetting can be caused by an underlying medical condition like infections or weak bladder muscles, it is necessary to get an evaluation done by a medical practitioner and start treatments for the same.

Parenting approach: It is important for parents to be gentle and supportive instead of punitive towards the child. One needs to avoid criticism, teasing or blaming the child. An optimistic outlook toward the issue is necessary to nurture confidence in children. Children who wet the bed are not lazy and parents need to emphasize that the issue is not the child’s fault. In some situations, counselling helps the parents understand ways to manage the situation.

Behavioural techniques: Some changes in the form of limiting water intake two hours before bedtime, urinating right before going to bed, and using an alarm to wake up in the night to urinate, can be practised to reduce the chances of bedwetting. However, the techniques need to be adapted depending on the nature of the issue. In some instances, fluids are not restricted in order to help the child recognize signs of bladder fullness. A behavioural psychologist can help in providing support in this regard.

Bladder retention training: Parents can reach out to a psychologist who specialized in training parents and children to overcome enuresis. They help with identifying triggers, outline specific steps to achieve bladder control like holding the urine and delaying urination to strengthen the bladder muscles, using bed alarms to signal wetness, etc. Support is also provided with respect to dealing with the emotional consequences of bedwetting which can impact the self-esteem of the child. 

Instilling responsibility: Parents need to interact with their children in a way that encourages the child to be independent and responsible. For example, depending on their age, making them put their wet bedsheets for washing and laundering them, putting clean ones on the bed on their own, etc. can help the child feel accountable as well as give them a sense of control over their situation. Children should be treated with respect during this process, and they should not feel that they are being punished for their bedwetting. 

Reinforce dry nights: It helps to come up with a reward system after implementing the above-mentioned strategies. A child can get one star/sticker for each dry night and later a collection of these stickers can be exchanged for a mutually agreed-upon reward (activity reinforcers) like a visit to the park or an aquarium.

Conclusion

Bedwetting can be a very distressing experience for the child. If left untreated, it can prolong into adulthood and cause emotional difficulties. If medical issues are ruled out, it helps to consult a counsellor or a behaviour therapist for overcoming bedwetting and related concerns. We at Cadabam’s can provide the necessary support to you or your child to manage this issue. Reach out to us for more information and help.

Dr Nisha Vidyasagar

Consultant Clinical Psychologist