nocturnal enuresis

Demystifying bedwetting

A child wakes up in the middle of the night, pulls the bedsheets off, puts them in the wash, and then sleeps on the floor to avoid embarrassment, ridicule, and humiliation. The child also avoids sleepovers with friends and never invites them over. While this isn't a problem every night for most children, the unpredictability of bedwetting can be enough to affect their self-image and self-esteem, confidence, and social interactions.

What can be done about it? What is enuresis?

According to Taber's Medical Dictionary, nocturnal enuresis is "the involuntary leakage of urine past the age at which a child should have bladder control, normally around age 5." Most often, the involuntary leakage occurs at night while the child is asleep, waking them up. According to the National Kidney Foundation, enuresis 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 firstborn children than in younger siblings. There is also a hereditary factor.

The causes of bedwetting

Bedwetting can be caused by one or more factors. These include poor bladder control, irritable bladder, 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 floor muscles. However, the most common cause of bedwetting in a child is a bladder that develops more slowly than the rest of their body.

The most common causes of bedwetting remain problems with bladder control, 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 bedwetting is hereditary is not clear, but it is evident 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 more likely to wet 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 know it does. “My son is 10 years old and has wet the bed his whole life,” says Denise, a mother from Mays Landing, New Jersey. “His father and several of his aunts wet the bed until they were teenagers. We feel like it runs in the family. We’ve never made a big deal out of it and have let our son know that 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 something. It will be his choice.”

The effects of bedwetting on children

Children who wet the bed often experience embarrassment or humiliation. These children know they are old enough to go through the night without wetting the bed, and they may feel helpless when an "accident" occurs. The child may also feel ashamed because of an episode of bedwetting. All of these feelings can lead them to see themselves as a failure, which affects their self-image and self-esteem. According to Dr. Sheldon, the feelings caused by bedwetting episodes can extend to other areas of the child's life.

A child who wets the bed can go through all sorts of emotions, he says. Feelings such as embarrassment, fear of being found 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 that they can't control their body, which can inhibit them in other areas of their life, such as sports, friends, and socializing. Bedwetting—and especially the feelings a child is likely to experience after an episode—can affect more than just their sleep. "My daughter is now 5 and often has 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 also manifest in other aspects of her life. We're being patient." She's a sensitive child, and we need to keep that in mind in all aspects of her life. We just dry the bed and put on clean sheets. It washes off, and a hug and a kiss do the rest.

Responding to episodes of bedwetting

One of the most important aspects of any bedwetting episode is how the parent or caregiver reacts. According to Paul Coleman, author of a book on bedwetting, a harsh reaction can worsen the problem. It's important to help the child understand the issue without causing further humiliation, Coleman says. Since the child is likely already stressed—and stress can cause bedwetting—adding more stress only exacerbates the situation, trapping both parent and child in a 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 frustration 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 help. Once the bed is wet, say, "It's okay, take the sheets off and I'll put on fresh ones." There's nothing wrong with the child preferring to make the bed themselves—they may be embarrassed. It's also okay if the parent asks the child to do it 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. For others, professional help may be needed to overcome the problem. There are several things a parent can do at home to help with bedwetting.

Dr. Sheldon says one of the first steps in helping a child with bedwetting is to limit fluids two hours before bedtime. Since fluids increase the amount of urine produced during the night, limiting the amount a child drinks before bed can often reduce the number of accidents. For children who don't have conditions like diabetes or blood disorders, or who aren't prone to dehydration, limiting fluids before bed will often decrease the frequency of bedwetting, he says. Making it a habit to take the child to the bathroom before bed is another way parents can intervene at home. According to Dr. Sheldon, by emptying their bladder before bed, children can reduce the incidence of bedwetting by one night per 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 independently, thus reducing bedwetting. Using disposable underwear is another strategy. Waking up dry can have positive effects on a child's self-esteem, reduce stress, and help both parents and child persevere through bedwetting episodes. Furthermore, using disposable underwear allows the child to participate in sleepovers or host them 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 lead to very good results in reducing the frequency of bedwetting. But if parental intervention isn't working, don't be afraid to ask for help. If your child needs additional support to overcome bedwetting, consult your doctor. Treatment can range from bladder training to administering medication before bedtime. Depending on the frequency and consistency of the bedwetting, a treatment plan is developed specifically for each child.