Bedwetting (also called enuresis) is sometimes classified as a parasomnia- any of a number of sleeping related disorders that cause undesired or unconscious action while asleep; in this case uncontrollable urination while asleep. Bedwetting is a common problem among children who have not yet fully mastered control of their bladder, but can also carry on or begin later in life.
Bedwetting is defined as uncontrollable urination in individuals who are expected to have developed bladder control by that point. Babies naturally are not considered bedwetters. The age at which bladder control should be expected can vary. Many parents believe it is around 3 years old, and tied to their toilet training development, though these may be unrelated. Physicians more liberally believe that 5 years old is a fair age to expect full bladder control, including control while sleeping.
Bedwetting on a rare basis is not considered serious, though it could have the same psychological effects. The general consensus is that wetting the bed twice a week on average classifies it as a sleep disorder.
Bedwetting decreases rapidly as children get older, whether through treatment or naturally. As many as 20% of children aged 5 years-old wet their beds, with just 5% of 10 year olds, and 1-2% of adults doing the same. Studies have demonstrated that adults are unlikely to experience a spontaneous resolution of bedwetting, and will often need treatment to remedy it.
There are two main processes that develop to prevent bedwetting; the most obvious is the ability to sense and wake up when the bladder is full. The other is a hormone burst that reduces the production of urine in the kidney, decreasing the chances of a full bladder during sleep. Most children develop this by the age of 5, but some may not develop until their teen years, or not at all.
The causes of bedwetting are many. Genetics plays a strong role. Children born to parents who did not wet their beds will have only a 15% chance of doing so themselves. Children born to parents who both wet the bed are 5 times more likely to also wet the bed, at a rate of 77%. Infections or diseases, namely urinary tract infections can cause bedwetting. This falls under secondary bedwetting, and resolves when the condition is resolved. Physical abnormalities are the cause of some bedwetting cases. This can include decreased bladder size. Finally, production of the above mentioned hormone can increase the risk of bedwetting, especially in children who have not yet developed the ability to wake up upon bladder filling. Children with attention deficit disorder are 2.7 times more likely to have bedwetting problems as well, which may indicate the need for well developed mental faculties to control bedwetting. Other causes can include too much caffeine intake, stress, constipation, and deeper rooted psychological issues.
The psychological effects that bedwetting can have on children are strong. How parents deal with their children’s bedwetting will further dictate the child’s emotional state concerning it. Parents should be supportive and understanding of the problem, realizing that it is entirely sub/unconscious. Bedwetting can hamper a child’s self esteem, and limit their desire to engage in overnight stays with friends, or go on camping or other overnight trips where they’ll be in a room or bed with other people. They will likely endure humiliation from siblings or friends who are aware of the problem as well. Children with bedwetting ranked it as the 3rd most stressful event in their lives.
There are many available treatments for bedwetting. A doctor should first be consulted, and your child given an exam to try to determine the cause of the problem. This will help identify any physical causes. If none are found, an attempt can be made to find the underlying cause.
Behaviour modification is a good step for eliminating the problem by enforcing positive routines in a child’s life that become second nature after extended use. Limiting a child’s intake of fluids when approaching evening hours is a simple and effective way to help limit bedwetting. Personally waking the child every few hours, or having them set an alarm to wake themselves and use the bathroom, is another option. Bedwetting alarms have demonstrated good results in conditioning children to recognize when their bladder is full. The alarm is a pad placed under the child as they sleep, and sounds at the moment of sensing moisture. This awakens the child, and conditions them to the feeling in their bladder at first waking.
Diapers can also be used to lessen a child’s embarrassment about bedwetting, but this is not a solution, and in fact may worsen its occurrences by making the child even less conscious of the events.
If the bedwetting is being caused by lack of production of antidiuretic hormone, the medication, desmopressin can be used.
Other medications exist to treat bedwetting, but these should be discussed with your doctor and based on your child’s medical history and other factors before being prescribed.