Tackling bedwetting in children

Q “What is the best training to end bedwetting among children? My niece is turning 10 and still wets her bed yet her other siblings as young as four are just fine.”

***

The question of bedwetting (Enuresis) is one that bothers many parents and is also the source of great distress to millions of children all over the world. In the medical classification systems of disease, it is found in the same chapter as a condition known by the name encopresis, or the problems associated with the control of the elimination of feces.

Before we go further in this discussion, one must bear in mind that the control of the process of the elimination of urine (and feces) is part of the development process, and the disease is thus said to exist when the patient continues to wet the bed or clothes beyond the age at which they should have stopped.

So, a two-year-old who wets herself at night is normal while a 10-year-old who wets his bed is not.

The cut off point is normally the age of five. A child aged five or more who wets the bed more that two times a week and does so for more than three consecutive months can be diagnosed with the condition.

Just to make your life a little more complicated, there are two types of this condition, one in which the child wets the bed at night and the other when the child wets their clothes during the day.

The wetting of bed at night is associated with the phase of sleep called rapid eye movement (REM) and the child will often state that the bed became wet following a dream about passing urine.

So, for example he/she will tell of a dream in which they had gone camping and he went behind a bush to pee, and soon after woke up in a wet bed. The stage at which dreaming, and bed wetting take place is one of very deep sleep.

Wetting one’s clothes during the day, (diurnal enuresis) is a completely different condition and causes much distress to the child, and the family.

In one type of this condition, the child seems to be so busy concentrating in activity say playing or reading that they ‘forget’ to pass urine until it is too late. (Voiding postponement). Such children might have other problems of concentration. In these children, the urinary system is completely normal, and the problem is that of the child being unable to pay attention to the gradually filling bladder until it is too late, and he only become aware when the floodgates of the bladder have opened. The other type of children is often found to have ‘weak bladder’ muscles to the extent that they are unable to reach the toilet on time.

You may also want to know that some types of enuresis tend to run in families meaning that the transmission is through the genes.

Now for some stories.

A few years ago, a nine-year-old girl was brought to us for the evaluation of what was clearly, secondary enuresis, meaning that at the age of five she had gained full bladder control but at the age of nine she had lost this control. The family was very distressed, and they wanted to deal with this disciplinary problem, of poor behaviour. A pastor had told them to seek the help of a mental heath expert even as they continued to pray for the girl.

During evaluation of the girl, it became clear that the problem started soon after her mother got a new boyfriend who would spend some weekends at their house. He was also a heavy drinker who often became physical with the mother. It later transpired that both the girl and the mother were clinically depressed. The girls presenting symptom was that of enuresis, and that of the mother severe weight loss. Both had severe social impairment. The girl could no longer go for sleepovers with her friends, and the mother was on the verge of losing her job on account of poor concentration and feelings of hopelessness and extreme irritability at work.

Soon after the child was brought to us the man left and mother and daughter were back together, and the stress caused by the weekend visitor came to an end. It turned out that girl had developed symptoms of depression and anxiety on account of the fear for the safety of her mother.

Secondary enuresis, therefore, is sometimes a reflection of an anxiety/depression state.

Coming back to your question therefore, you must establish the cause of the bedwetting before embarking on the solution. Get the child to an expert as soon as possible if you are to avoid further pain and suffering.