Bed-wetting is not a new topic to any of us- in fact, if you grew up like me, you probably don’t think it is that big of a deal. You are right! However, in some cases, it may affect the child’s emotional well-being and even the parents.
Were you ever denied permission to go for sleepovers or camps with your friends when you were younger because your parents did not want you to embarrass them? Did you ever get laughed at or mocked by your peers while playing? Did you ever get blackmailed by your siblings into performing chores for them with threats that they would tell on you in school? As a parent, do you feel like your child should have outgrown bed-wetting by now? Has your child’s bed-wetting lasted longer than what is considered normal? This is where most of our self-esteem issues begin. These are very common problems – more common than you know- but I hope after reading this article, you will handle these “accidents” differently.
Bed-wetting otherwise known as nocturnal enuresis, nighttime incontinence or sleep enuresis is defined as loss of bladder control at night after the age at which bladder control ought to have been achieved.
Bed-wetting is a normal part of a child’s development process. For some reason, it is more frequent in boys than girls. Every child develops differently, and there are many factors that determine when your child will achieve certain developmental milestones. Full bladder control is a milestone that should be achieved by the age of 6–7 years. Studies show that by the age of 6 years 1 out of 7 children, 20% of 5-year-olds, 5% of 10-year-olds and 1% of 15-year-olds will still have bed-wetting habits.
Bed-wetting below the age of 6 years does not need any medical intervention unless the child has other associated symptoms
Therefore, bed-wetting below the age of 6 years does not need any medical intervention unless the child has other associated symptoms, or it affects their emotional well-being. For most children, it is more of an inconvenience than a medical illness. Developmentally speaking, at 7 years, you should begin to get concerned if your child can’t stay dry at night.
If your child bedwets only once or twice a week at the age of 6 years, they will most likely attain full bladder control within a few years. It is considered a variation in the age at which this particular social requirement is achieved. During my short time working in paediatrics, I’ve rarely seen bed-wetting as a primary reason for hospital visits. This indicates that most parents are aware that it’s a common developmental issue.
What causes bed-wetting and when to seek medical intervention?
For the purposes of clarity, I will classify bed-wetting into three categories;
• Primary bed-wetting – this is when a child has never been able to stay dry at night
• Secondary bed-wetting– this is when a child begins to bed wet after 6 consecutive months of staying dry at night. This type of nocturnal enuresis signals to an underlying medical condition.
• Temporary bed-wetting – this happens after the death of a close friend, separation from parents or birth of a sibling.
“Bed wetting is a developmental issue and therefore the treatment is time, so kids below 6 years will most likely grow out of it.’’ — Charles Sihubin, director of the children’s health centre at Mercy Family Care in Baltimore, MD1.
Here is a list of some of the causes of nocturnal enuresis:
1. Developmental milestone delay
Children are normally born with reflexes called primitive reflexes, which should disappear as they grow older. These reflexes are usually replaced by higher-level conscious reflexes during the first year of life. For some children, the primitive reflexes continue even after the first year of life. This can be due to a traumatic birth, neck subluxations, chronic ear infections, etc. One of the reflexes that if retained after the first year of life can cause bed-wetting alongside other developmental delays is the spinal gallant reflex. Therefore, If you notice other developmental delays in your child, you should visit a paediatrician.
It is important to note that most of these children do not have neurological disorders. In fact, there has been no association with conditions like epilepsy. The problem is usually more of external sphincter control. Abnormalities higher in the urinary tract were found to have no significant role.
2. Deep sleep
Some children usually go into very deep sleep such that they don’t usually wake up to empty their bladder. However, not all children who wet their beds are deep sleepers.
Some children who experience sleep apnea (a serious medical condition where breathing repeatedly starts and stops) also get nocturnal enuresis.
“As adults, when the bladder gets full, it sends a signal to the brain to wake up, or you start dreaming about water or going to the bathroom, then you wake up, but for kids the signal isn’t quite strong enough to wake them up.”— Greene
3. Small/ weak bladder
Children have small bladders. Thus, they can only hold a little amount of urine before the bladder gets full. As they grow older, the size of their bladder increases.
4. Genetics
Bed-wetting is more likely to occur if a parent, sibling, or other family members has had the same issue. The chances of a child developing bed-wetting are 70% if both parents had bed-wetting as children and 45% if one of the parents experienced it, as compared to only 15% if neither of the parents experienced it.
5. Psychological factors
Bed-wetting is more common in children who are diagnosed with Attention deficit hyperactivity disorder (ADHD).
Stress, anxiety, or insecurities can also trigger bed-wetting and this should be addressed early enough before it becomes a problem to the child. Anything that triggers emotional stress in a child e.g., parental conflict or neglect, hospitalization, abuse, psychological trauma or broken homes can lead to bed-wetting. Children with mental disorders can also present with bed-wetting, among other symptoms.
It is also associated with feelings of shame, embarrassment, and guilt, which are likely to make the situation worse than it is.
6. Hormonal imbalance
Antidiuretic hormone (ADH) is the hormone that is responsible for low urine production at night. Any chronic disease that affects ADH production can cause bed-wetting. Low ADH production makes the child not able to hold higher volumes of urine.
7. Poor bathroom habits
Holding urine for too long during the day can alter normal bladder control.
8. Constipation
A distended bowel can put pressure on the bladder, which shrinks its capacity. This child will have other symptoms e.g., reduced bowel movement, pain during bowel movements, hard stools. Little appetite, tummy aches etc. Here, the body takes a lot of time to digest food.
9. Acquired urinary tract problems
Bed-wetting can also be caused by problems in the urinary tract such as tumors or urinary tract infections (UTIs), the latter being more common. If your child develops bed-wetting plus other symptoms like pain during urination, blood in urine, strong odor in urine, cloudy urine, lower back pain, frequent or urgent need to urinate, fever etc. you should take them to a hospital.
10. Caffeine
Caffeinated or alcoholic drinks usually irritate the bladder and may also act as diuretics (cause more urine production). It is therefore important to avoid giving your child caffeinated drinks before bedtime.
11. Diabetes
Type 1 Diabetes is also a likely cause of bed-wetting and one that needs to be ruled out. A diabetic child will produce more urine than a normal child. They will also present with other symptoms like excessive thirst, weight loss, blurred vision, frequent urination, tummy pain etc.
12. Sexual abuse
A child who is sexually abused can get secondary nocturnal enuresis. You can look for other signs e.g., vaginal pain, discharge etc.
13. Medications
Certain medications that increase urine production can cause bed-wetting.
These are just some of the causes of bed-wetting. If any of these fit your child’s description, please visit a doctor. In conclusion, bed-wetting is not your child’s fault. They do not do it intentionally, and scolding or shaming them only makes the situation worse that it already is. Next week we’ll share tips on how to manage and treat bed-wetting.
