Bed-Wetting: When Is It a Problem?

There may be no kids in the world who have never wetted their pants or bed, especially at night. In the minds of most adults, the concepts of “bed-wetting” and “a small kid” go side by side in the most logical way. But where is the age line beyond which bed-wetting in children is perceived as deviation rather than the norm? And how to treat bed-wetting in children?

According to statistics, about 20% of all children under 5 years of age suffer from enuresis.

Enuresis in children: a disease or weakness of character?

Overly concerned parents should be told straightforward that no examining or medical study has shown any abnormalities or defects in the body of a vast majority of kids with enuresis (when urinary incontinence is the only reason for concern): these children’s excretory system and nerves are functioning in a proper way. Thus, enuresis in children is not considered to be a disease even in a strict medical environment. Doctors emphasize that bed-wetting in children is not a disease; it is a temporary phenomenon, which completely disappears over some period of time in 95.5% of cases.

Only in very rare situations, bed-wetting in children may develop due to certain physiological abnormalities – for example, the kid’s bladder capacity is too small, etc.

As a rule, ordinary pediatricians believe that children “have the right” to wet their pants until around the age of 4 years. Enuresis at this stage of development of the organism is a perfectly normal and tolerated phenomenon. And there is no reason to worry about it.

Although there are experts who let the kids have more time – for instance, 7-8-year-olds can wet their bed in the middle of the night without waking up. And it is also considered a normal, physiologically acceptable phenomenon rather than a cause for concern and irritation.

The fact is that the mechanism controlling urination “matures” in children gradually during the first 10-15 years of life. Very small babies generally cannot control the performance of their excretory system; during the sleep and during the moments of waking; for them it is normal to pee and poop in diapers at any time. There are no adults in the world (including pediatricians), who thought it was an unnatural and abnormal phenomenon.

But in the process of growing, the children’s nervous system is gradually becoming more perfect. At about the age of two, children are already capable to suppress the urge to urinate or defecate for some time before using a potty. And by the way, from the age of 2-2.5 years, the kid begins to get systematically accustomed to a potty – so it’s just pointless to practice doing this at an earlier stage.

And even when the child’s nervous system gets mature to the point where it can send a signal to the brain each time the bladder is filled and needs being emptied – even in this case many children do not awaken each time during sleep, having received such a signal. And it does not depend on the quality of sleep or the weakness of the bladder – the kid just has not trained his/her body to get up to the sound of this internal “alarm clock”. In 99.5% of cases, time is needed – as the kid gets older, he/she is awakened more easily at night when it is necessary to relieve nature.

If a four or six-year-old child is wetting bed less and less often with time – this is a good reason for parents not to worry about anything. Even the mere presence of enuresis in children is not yet the reason for parental alarm! This is normal. It is not the mere fact, but the dynamics that is important here! If a kid is wetting his/her bed not often, but about the same number of times per month, and no dynamics is observed for the symptoms of enuresis to reduce, this is the case when you need to talk to your doctor.

Causes of enuresis in children

Typically, doctors divide the concept of “childhood bed-wetting” into primary and secondary enuresis. Primary enuresis refers to a situation in which the kid is wetting his/her bed from birth from time to time (especially during the night) and still is not able to control the process of waking up and going to the toilet. Secondary enuresis illustrates the case when a child has successfully coped with nocturnal urination for some time (i.e. got up and went to the toilet), but after a while he/she began to sometimes pee straight in bed without waking up.

The causes of primary bed-wetting in children usually are:

• Physiological immaturity of the urinary system;
• Temporary lack of response to the urge to urinate.

The causes of secondary enuresis can be:

• Stress;
• Nightmares;
• Chill in the room where the baby sleeps (strong urge to urinate is the standard response of the body to cold, so the body is trying to reduce the amount of circulating liquid and concentrate all the hot blood around vital organs);
• Overeating, especially for dinner;
• The habit of drinking plenty of fluids before bedtime.

There is an inexplicable fact that of all children with enuresis there about 70% of boys and only 30% of girls.

Enuresis in children: treatment

The only thing that can really effectively treat childhood bed-wetting is the time factor. And parents’ patience as well. As the child grows, there is also development and improvement of his/her nervous system, elements of which always play a role in the normal performance of the excretory system (and many other systems).

In addition to time, children with enuresis will find the so-called motivational therapy to be helpful. It does not presuppose taking any medicine, it does not include special exercises or training; it consists in the child’s trivial desire to stop doing something (in this case – to stop wetting bed at night).

Motivational therapy in the case of enuresis in children is the most effective method of treatment. It lies in the fact that parents should constantly encourage the child’s desire to wake up in a dry bed in the morning. Your moral support, gifts for “dry” nights, verbal praise etc. contribute to recovery.

Usually, doctors recommend the following regime of motivational therapy for children older than 5-6 years:

1. You need a lovely wall calendar in the child’s room. You also need to buy a stock of fun stickers that your kid will admire.
2. On this calendar, you stick colorful and funny stickers to mark your kid’s night wins – that is, whenever the baby woke up in a dry bed in the morning you stick a “winning” sticker on the calendar. Then you explain to the kid how much you are proud of him/her for each new sticker.
3. Seven stickers in a row (hence, seven consecutive “dry” nights) – and the kid gets a present (decide in advance what it is going to be: a new book, a coveted visit to the circus, etc.; the child should understand from the very beginning what he/she is competing for)…
4. Statistics confirms that motivational therapy is very effective in the treatment of childhood bed-wetting. Despite the simplicity and “playfulness” of the method, it completely eliminates kids’ bedwetting at night in 80 cases out of 100 during the period of about 3 to 8 months.
5. Also, if you can determine the cause of secondary enuresis in your kid (e.g., a scary cartoon watched before going to bed, or a severe quarrel of the parents, etc.), you need to resolve this possible problem: to buy good cartoons instead of terrible ones, to stop the “vicious” practice of quarreling in the children’s presence, etc.
6. It is natural that using motivational therapy you should not even try to test the kid deliberately, if he/she can have a dry night or will wake up in a wet bed again. Do not let the child drink much water in the afternoon and before bedtime! Try to create such conditions when the dinner is light.
7. Numerous studies have shown that such methods as hypnosis, classical psychotherapy, acupuncture and herbal medicine are not effective kinds of treatment for enuresis in children.
8. Finally, there is another method of treatment of bed-wetting in children that is called “bladder training” by urologists. The point is to persuade the kid not to urinate for a few minutes whenever he/she is asking for a potty. Thus, the volume of the bladder will increase gradually, and the child will learn to hold on a little longer when the first signs of the needed urination appear.

Enuresis? The child has no fault!

There are some studies showing that many parents punish their children (sometimes even by means of corporal punishment!) because the kids may occasionally wet their bed at night. There is nothing more absurd and cruel than punishing a child for the thing that he/she is not physically able to control yet.

Remember that children are not to blame for wetting their bed! And no pedagogical methods (especially punishing them, or making them feel ashamed, or mocking at them) can influence the frequency with which this “trouble” occurs and the age to which it will last.

The best thing you can do is to show your child how much you love him/her no matter what, to show your willingness to support and cheer him/her up, and to begin to use motivational therapy to treat enuresis.

Remember that in 99.5% of cases of bed-wetting in children, it is cured completely over time. It usually disappears long before you have a real reason to start worrying about it…