Causes of Bedwetting

 Reprinted with Permission from
Potty Training and Bedwetting Solutions

The most common reasons for a child suffering from bedwetting are as follows: developmental delays (as mentioned earlier), genetics (same here), sleep disorder (such as sleeping too deeply), behavior and psychological disorders, anatomy, antidiuretic hormone levels.

The most commonly accepted, but also hardest to prove, cause of primary nocturnal enuresis is maturational delay of the central nervous system. Basically meaning that the child’s nervous system doesn’t sense that the bladder needs to be held, and the urine is released during sleep.

Sleeping disorders make up a very large percentage of children who suffer from bedwetting, and there has been extensive research done on the subject, but there have been such varying results, that it is hard for researchers to determine a primary sleep disorder that can be determined as the main cause for bedwetting.

Some people believe that bedwetting is mainly caused behaviorally, which leads to the issue of psychological consideration- some studies have shown that psychologically children who suffer from nocturnal enuresis have essentially the same behaviors as children who don’t, while other studies have concluded the opposite. In those studies that show psychological differences between the two groups, the differences have mainly been that a child who has a bedwetting problem is less social and has more self-esteem issues than the other group. This begs a question though: do the low self-esteem and social issues go hand in hand with bedwetting children, or does the bedwetting lead to these types of psychological situations in these children?

Family history is also very important, and many studies have shown results that deem it almost conclusive that if a parent suffered from bedwetting as a child, there is a very strong chance that their child will. In fact, one study showed that in a family where both parents suffered from this condition, there was a 77 percent chance that their child would do the same. This is a helpful finding, because it helps dispel the theory that enuresis is a behavioral problem. In turn, this makes it more acceptable, and causes slightly less frustration and guilt, which can lead the way for a better outcome following therapy.

Treating bedwetting

In the beginning of trying to deal with a bedwetting situation, you may opt to try different methods of battling it without the interference of doctor or medical care. Whether or not medical intervention will be necessary depends largely on many factors, including such issues as the child’s age, how often they actually wet the bed, and the perceived severity of the problem by the child’s family, and most children actually do outgrow bedwetting, never needing treatment for it by a physician at all.

Many parents use night time diapers to battle bedwetting, and while these work great in preventing the bed from getting wet due to the accident, they actually do very little in the way of helping resolve the issue. Although it is obviously very important to focus on this part of bedwetting, it is also very important to try to prevent future occurrences. This is why is a good idea to try and step in as early as possible to use many basic methods of prevention. Then, when these don’t work, you may decide to take your child to the doctor. You should know, though, that children younger than six years of age are usually not treated by doctors if bedwetting is the only problem.

Once you have decided to take your child to a physician concerning bedwetting, it is important to know that it may take a long time to actually reach the ultimate goal of completely accident-free nights. It is a long process in which both the parent and the child must remain dedicated. There are two methods which doctors utilize to deal with bedwetting problems: behavioral therapy and medicine. It is extremely important that the parent and child be as cooperative as possible, and be willing to try the doctor’s suggestions. If anyone has a bad attitude about the situation, it can make solving the problem a whole lot harder, if not impossible.

When you first take your child to the doctor, they will most likely want to rule out any medical conditions in the very beginning. While most of the children who are seen by physicians regarding bedwetting are perfectly healthy, some actually do have a medical condition. So, before a doctor will approach it as if they don’t, they will want to make sure that this really is the case. The evaluation the doctor does on your child should be geared toward ruling out anatomic abnormalities of the urinary tract or bladder. These can include such situations as posterior urethral valves, an ectopic ureter, or an epispadiac urethra, which is a urethral opening on the dorsum of the penis. When the doctor does a thorough exam, which will include gathering family medical history, a physical exam, and a urine evaluation, they are usually able to determine whether or not there is a medical condition and, if there is, what that condition might be. When, and even before, your child is being medically treated for enuresis, it is an excellent idea to keep a diary of bedwetting episodes. Along with this diary, if the child’s bedwetting does not occur repetitively on a nightly basis, it is a good idea to write down anything that might have occurred that day to upset your child’s normal psychological balance.

Once the doctor has determined whether there is, or is not, a medical condition contributing to your child’s bedwetting situation, they can determine which methods of treatment will best help them. Again, it is important to remember that consistent follow-up can be a key to improvement in bedwetting (it is also good to know that improvement is usually defined by most doctors as a 50 percent decrease in the frequency of bedwetting episodes).

Your doctor may decide to use just one method of treatment or both in conjunction with one another. The behavioral methods can, and usually do, include the following: an alarm system, a reward system, asking your child to change the sheets, and bladder training.

An alarm system  can be an excellent tool for helping by retraining your child’s sleeping patterns so that they sleep more lightly, and wake up more often during the night, allowing less time for an accident to occur. You can set these for a certain amount of time and have your child get up and try to use the restroom every time the alarm goes off.

A reward system can also be a very successful method of behavior therapy, especially once the child has learned new sleep patterns and is having less frequent accidents. Giving them either a small reward each day after a dry night, or a large reward at the end of a certain length of time, such as an entire week of dry nights, can help give your child even more incentive to try to wake up at night.

Having your child change the sheets is also an excellent way to help keep them from having as many bedwetting nights. While it is never good to punish a child for something they have little to know control over, this is not punishment, and is instead a way for them to learn that they have to be responsible for their actions, even if those actions occur while they are sleeping. This also works well because they are having to get up out of bed and be pulled from the deep sleep more often, which in turn can lead them to sleep more lightly on a regular basis.

Bladder training is another form of behavioral therapy that can help limit bedwetting nights. This is defined by, during the day, having your child hold their bladder for longer and longer periods of time. They may always go to the restroom immediately when they feel the urge to go, and so when they are in a deep sleep, that is how their body reacts when that urge hits them. If you teach your child to hold it for as long as they can when the urge comes while they are awake, they are more likely to be able to hold it subconsciously while they are asleep.

If behavioral therapies do not work, and only if the child is 7 years of age, or older, medicines may be prescribed. Medicines work best in conjunction with behavioral therapy, because they are not a cure for bedwetting. They also may have side effects. If you do decide to go with medicines as a treatment option for your child, there are two common kinds, one of which your doctor will likely prescribe. One of these helps the bladder hold more urine, and one helps the kidneys make less urine. Obviously, these are not the types of drugs you will want your child to have to take consistently for the rest of their life. Instead, they are best when used temporarily in conjunction with the behavior therapy mentioned earlier.

Helping your child cope with bedwetting

Not only should you try to help your child overcome their bedwetting problem, but you should also focus on helping them to understand it and not feel quite so bad about it, if at all possible. Your child likely feels very ashamed at being a bedwetter. They may also feel guilt for not being able to control their body in a way that they feel they should. This is very likely in older children. You should never punish your child for this problem. It is very important to remember that your child cannot help it. Again, the older the child is, the more this applies, and your child is likely even more irritated about it than you are. You should try to not make your child feel any more guilt about it than they already do.

It may also help your child to know that no one really knows the exact cause of bedwetting, because there are too many factors that have to be considered in each case. Explain to them the many different causes that might be affecting their situation, and the fact that these reasons are not their fault, and that you will help them overcome it. Tell them as much information as is necessary to help them be able to deal with it without thinking less of themselves. For instance, if you wet the bed as a child, be sure and explain this, while also informing them that it can run in families. This might help take some of the pressure off and relieve some of their guilt.

Just remember, this is a rough time on both you and your child, and you should use whatever methods necessary to dispel your bedwetting difficulties. Keeping the right no-fault attitude can definitely help, as well as having an open mind to suggestions for treatments, and being dedicated to whatever ways you decide to treat bedwetting and/or potty training.