Nocturnal enuresis

Demystifying Bedwetting A child wakes up in the middle of the night, strips the sheets off the bed, puts them in the wash, and then lies on the floor to avoid embarrassment, ridicule, and humiliation. The child also avoids sleepovers with friends and never invites them to spend the night. While for most children, this isn't a problem every night, the unpredictability of bedwetting can be enough to affect self-image and self-esteem, confidence, and social interactions. What can be done about it? What is bedwetting? According to Taber's Medical Dictionary, bedwetting is "the involuntary flow of urine after an age when a child should have bladder control, normally around the age of 5." Most often, involuntary urination occurs at night while a child is sleeping, waking them up. According to the National Kidney Foundation, bedwetting affects approximately seven million children in the United States alone. The problem is more common in boys than girls, and is more likely to occur in firstborns than in younger siblings. There is also a hereditary factor. Causes of Bedwetting Bedwetting can be caused by one or more factors. These include poor bladder control, irritable bladder problems, stress, trauma, urinary tract infections, increased fluid intake, diabetes mellitus, or, in a small percentage of cases, a serious condition affecting the spine or pelvic muscles. The most common cause of bedwetting in a child, however, is a bladder that develops more slowly than the rest of the body. The most common causes of bedwetting remain bladder control problems, infections, fluid intake, stress, and trauma, says Dr. Stephen Sheldon, director of the Sleep Medicine Center at Children's Memorial Hospital in Chicago, Illinois, adding that diabetes is among the more serious causes. In addition to these factors, heredity can also play a role in the presence of bedwetting. According to Dr. Sheldon, the reason why bedwetting is hereditary is unclear, but it is clear that the problem is passed down from parent to child. If one or both parents wet the bed when they were young, then their child is at greater risk of wetting the bed as well, he says. Many health problems and hereditary diseases can also contribute to bedwetting. That's why it's so difficult to say why it runs in families, but we do know that it does. “My son is 10 years old and has been a bedwetter his whole life,” says Denise, a mother from Mays Landing, New Jersey. “His father and several of his aunts wet the bed well into his teens. We feel like it runs in families. We’ve never made a big deal about it and have let our son know it’s very common. If it starts to really bother him and he asks for help, we’ll talk to him about the options… and see if he wants to try anything. It’ll be his choice.” The effects of bedwetting on children Children who wet the bed often feel embarrassed or humiliated. These children know they are old enough to get through the night without wetting the bed, and they may feel helpless when an "accident" occurs. The child may also feel ashamed due to a bedwetting episode. All of these feelings can lead them to perceive themselves as a failure, which affects their self-image and self-esteem. According to Dr. Sheldon, the feelings generated by bedwetting episodes can extend to other parts of the child's life. A child who wets the bed can experience all sorts of emotions, he says. Feelings like embarrassment, fear of someone finding out, or feeling like a failure don't stay confined to the bedroom. A child who wets the bed may feel like a failure or like they can't control their body, which can inhibit them in other areas of their life like sports, friends, and outings. Bedwetting—and especially the feelings a child is likely to have following an episode—may affect more than just their sleep. "My daughter is now 5 and often experiences bedwetting incidents when she's upset or stressed," says Crystel, a mother from Clemson, South Carolina. "The stress and feelings she experiences when she wets the bed manifest in other areas of her life as well. We're patient." She's a sensitive child, and we have to keep that in mind in every aspect of her life. We just dry the bed and put on clean sheets. It washes out, and a hug and a kiss do the rest. Responding to bedwetting episodes One of the most important aspects of any bedwetting episode is how the parent or caregiver reacts. According to Paul Coleman, author of the book on bedwetting, a harsh reaction risks making the problem worse. It's important to make the child aware of the problem without further humiliation, Coleman says. Since the child is already likely to be stressed—and stress can cause bedwetting—adding even more stress only makes things worse, leading both parent and child into a never-ending vicious cycle. How should a parent react to their child's bedwetting? Coleman suggests being reassuring. Empathy is key, says Coleman. Show the child that you understand their upset and help them understand that they are not alone in this problem. Reassure them that they are no different from other children and that with help, they will overcome the problem. Offer assistance. Once the bed is wet, say, "It's okay, take the sheets off and I'll put in fresh ones." It's okay if the child prefers to make the bed themselves—they may be embarrassed. It's also okay if the parent asks the child to do it themselves because they are too tired or busy. However, making the bed should not be perceived as a punishment. The tone should not be harsh. Having to make the bed will not motivate the child to overcome bedwetting. Help for bedwetting Bedwetting is a different problem for every child. For some, it's just a phase they'll outgrow as they grow. For others, professional help may be required to overcome the problem. There are several things a parent can do at home to combat bedwetting. Dr. Sheldon says one of the first steps in helping a child combat bedwetting is to limit fluids two hours before bedtime. Since fluids increase the amount of urine produced at night, limiting the amount a child consumes before bed can often reduce the number of incidents. For children who don't have conditions like diabetes or blood disorders, or who aren't prone to dehydration, limiting the amount of fluids consumed before bed will often decrease the frequency of bedwetting, he says. Making a habit of taking the child to the bathroom before bed is another way parents can intervene at home. According to Dr. Sheldon, by emptying their bladders before bed, children can reduce the incidence of bedwetting by one night a week. Parents can also wake their child once a night—about four hours after bedtime—to take them to the bathroom. This technique can often help the child develop the habit of going to the bathroom on their own, thus reducing the occurrence of bedwetting. Using disposable underwear is another strategy. Waking up dry can have positive effects on the child's self-esteem, reduce stress, and allow both parents and child to cope during periods of bedwetting. In addition, using disposable underwear allows the child to attend sleepovers or host them at home without fear of embarrassment. Parents should try to do what they can for their child through simple interventions at home, says Dr. Sheldon. Often, small things can go a long way in reducing the frequency of bedwetting. But if parental intervention doesn't work, don't be afraid to ask for help. If your child needs additional help overcoming bedwetting, see your doctor. Treatment can range from bladder training to administering medication before bedtime. Depending on the frequency and consistency of bedwetting, a treatment plan is tailored to each child.