Bedwetting is a form of enuresis, or loss of bladder control. Parental understanding of enuresis and support in overcoming the challenges will help children outgrow this condition.
Understanding enuresis is vital in overcoming the challenges of bedwetting. According to Dr Margaret Fockema, president of CASA (Continence Association of South Africa) and vice chairman of the Enuresis Academy of South Africa (EASA), the full medical definition of enuresis is “an involuntary voiding of urine during sleep. With a severity of at least three times a week in children over the age of five, in the absence of congenital or acquired defects of the central nervous system”.
“A child under the age of about four years who is wetting their bed should really not be considered enuretic,” says Trish Holgate, a social worker specialising in counselling children. “You may long for dry sheets, but your child may still not have the required bladder control. Expect the odd wet bed even once dryness has been achieved; it should resolve itself by about the age of seven.
Overcoming the challenges of bedwetting requires knowledge of primary and secondary enuresis.
Primary and secondary enuresis
Primary enuresis is when a child has never managed to achieve dryness at night. Dr Jacobus van Dyk, a paediatric endocrinologist, explains: “There are three contributing factors:
- going into a very deep sleep and not waking up from the sensation of a full bladder
- having a small functional bladder capacity
- over-production of urine while sleeping (polyuria), which is caused by a lack of an antidiuretic hormone.”
Secondary enuresis is when children who have achieved dryness at night begin wetting their beds again. Causes can be constipation, urinary tract infections and congenital defects, says Fockema. “A primary enuresis diagnosis can only be made once secondary causes have been ruled out, ” she explains.
“In my experience, the most common cause for secondary enuresis is an emotional crisis that causes anxiety. A child who is not able to express anxiety appropriately may well begin bedwetting,” says Holgate.
But Fockema disagrees. “Nocturnal enuresis was once thought to be a psychological condition, but studies now indicate that the enuresis itself is likely to be the cause of the emotional problems.” Contrary to how it may sometimes seem, a child who wets their bed is not being stubborn, manipulative or “naughty”. “You need to consider possible underlying causes so that they can be addressed. Armed with some understanding, you will feel like you have more of a plan and be able to respond appropriately,” says Holgate.
Solutions vary, depending on the cause and the nature of the enuresis. Firstly, the attitude of the parent plays a vital role in addressing this problem. “Attacking, shaming or punishing the child will only increase anxiety levels and make the problem worse. “Remain emotionally contained and show confidence in the child’s ability to eventually control his bladder function,” advised Holgate.”
Ask for help
If you are concerned, let your GP examine your child and advise you. “If over-production of urine is the problem, antidiuretic medicine can be given to slow down urine production at night,” says van Dyk. “It has an almost immediate effect of reducing urine output and therefore reduces bedwetting. It is very effective for special occasions such as sleepovers, when going through the night without wetting the bed is extremely important to the child. However, once the medication is discontinued, bedwetting usually reoccurs.”
No warm milk before bed
Changes in diet can also help. Certain foods such as dairy products, caffeine, carbonated drinks and acidic foods irritate the bladder. Consider also that a child’s bladder capacity increases by a mere 30ml per year during the first eight years of their life. Limiting fluid intake towards bedtime will help, but don’t be tempted to cut back during the day as this can lead to dehydration.
A method that is quite successful in stopping bedwetting is the use of a bed alarm. “You place a sensor, connected to an alarm, inside the child’s underclothes. The alarm will go off if the child starts to urinate,” says Fockema.
Each child is different and each will eventually gain total bladder control. Parental support and encouragement will help to make this a smoother, easier process for hildren.