Bed-wetting (enuresis)

Bedwetting, Wetting or Enuresis are terms for a childhood disease in which children and adolescents do not yet have the natural urge to urinate under control. Usually they soak in at night without even realizing it. Bed-wetting can have both psychological and physical (hormonal balance) causes and should be examined and treated by a pediatrician. Under no circumstances should children be punished for wetting the bed, as the condition then usually only worsens. Parents, children and doctors should work together to prevent bedwetting.

What is bed wetting?

Bed-wetting, wetting or enuresis are referred to when a child who is five years of age or older regularly wets during the day or at night. The duration of wetting varies from case to case. The problem persists into adulthood in around one percent of those affected.

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In this disease, a distinction is made between primary bedwetting and secondary bedwetting. Primary bedwetting is when a child has never been dry for a long time since birth. If there have already been dry phases of at least six months and the child wets again afterwards, this is called secondary bedwetting. However, bedwetting is much more common.

causes

The specific causes of primary bed-wetting are not clearly understood. Several factors are likely to play a role, although psychological problems are hardly significant in this form. Experts agree that primary bedwetting is a developmental delay in the child.

The affected children do not feel when their bladder is full. The controls that govern bladder emptying have yet to be fully developed. It is possible that this form of bed-wetting is also inherited, as there are families in which this problem occurs frequently.

Some research shows that the hormone vasopressin is insufficiently produced in many enuresis patients. This hormone controls the water balance in the body. If it is sufficiently available, less urine is produced during the night, so that you hardly or not have to go to the toilet at night.

The main causes of secondary bedwetting are usually emotional problems or sudden changes in the child's environment. Bed-wetting occurs particularly frequently, for example, when a family member is lost, parental separation or an imminent change of location.

Symptoms, ailments & signs

Bed-wetting manifests itself primarily through the unwanted leakage of urine (usually while sleeping in bed). This symptom has only limited disease value. For example, it is normal for children up to about the third or fourth year to go to bed. This can occasionally also happen later.

Primary enuresis is when prolonged bed-wetting is viewed as a developmental disorder. The symptoms here are wetting, deep sleep and polyuria. Diagnostics can also identify abnormalities related to the hormone ADH and possibly accompanying psychological symptoms.

Those affected notice that they are bedwetting at the latest the next morning. However, it can also happen that those affected wake up. The definition of enuresis is used to distinguish mild continence disorders: It is characterized by the complete loss of the contents of the bladder, while incontinence can also mean the loss of any amount of urine.

Secondary enuresis, on the other hand, means that unwanted urination occurs after a dry phase lasting six months at the earliest. This is also often associated with psychiatric symptoms, the frequent unwillingness to urinate (squeezing legs together and similar behavior) and a disturbed urination pattern. In addition, situation-dependent incontinence occurs in this context - for example when laughing or coughing.

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Course & prevention

The causes of bedwetting make it clear that a child is not intentionally wetting. Most of the time, those affected are highly motivated to get rid of bedwetting quickly and permanently. Therefore, parents should never blame themselves or the child. Punishments should also be avoided as they put the child under additional pressure. Rather, a reward helps every dry night.

It has been proven that the child records in a calendar for at least two weeks whether it was dry (sun) or wet (cloud). This measure alone often leads to success, as it gives the children self-confidence and thus stops wetting the bed.

In addition, care should be taken to ensure that the child does not drink large amounts of fluids before going to sleep. Drinks containing caffeine in particular stimulate urine production and promote bedwetting.

If the child still gets wet despite a lot of patience and good encouragement, an experienced specialist should be consulted. He knows best which individual treatment is best for a child. If a child gets wet due to psychological problems (secondary bed-wetting), these should be dealt with as soon as possible.

Complications

Bed-wetting often leads to social complications. Children with nocturnal enuresis are often unable to stay with other children. They are also often disadvantaged on school trips. Sometimes the children or parents avoid such opportunities, which can affect the social status of the child within the group.

Even if the child takes part in such overnight stays, bed-wetting is often associated with shame and feelings of guilt. Often there is also fear and depression, and even depression. Depression can develop fully in childhood. The clinical picture is characterized by a depressive mood and the loss of joy and interest.

Other psychological problems such as hyperactivity are also possible. It depends on the individual case whether bedwetting is the cause, consequence or side effect of another mental illness. The social complications are often greatest in diurnal enuresis. The psychological burden on the child increases accordingly if it wets itself during the day.

In addition, bed-wetting for psychological reasons is more common in children who suffer from abuse or neglect.This can lead to further complications, for example post-traumatic stress disorder (PTSD), behavioral problems, and anxiety, obsessive-compulsive and eating disorders.

Complications from treatment are very rare. Empathetic doctors and therapists can often help children overcome feelings of shame.

When should you go to the doctor?

Occasional wetting of a child's bed can have completely harmless triggers, such as very deep sleep. A visit to the doctor is then unnecessary. However, if this behavior occurs frequently, the causes should be clarified by a doctor. In any case, if bed-wetting occurs along with other symptoms, a doctor should be consulted.

A urinary tract infection is suspected, especially if the child complains of painful urination or frequent urination. When children wet themselves during the day, it is often a bladder dysfunction that requires medical attention. Signs of urinary incontinence are constant clenching of the legs, loss of urine when laughing or coughing, and very frequent urination while drinking normally.

If blood appears in the urine or if the child complains of severe pain, go to the nearest hospital immediately. These cases could be symptoms of a severe bladder or kidney infection.

A visit to the doctor is also advisable if the child was already dry and begins to wet again after a long time in bed. If no physical causes for bed-wetting can be identified, a child psychologist should be consulted in addition to a doctor.

Doctors & therapists in your area

Treatment & Therapy

For the treatment of primary bedwetting there are basically 3 approaches with the aim of completely and permanently eliminating bedwetting. Child psychologists in particular recommend behavior therapy. Among other things, the children's drinking behavior should be recorded and reflected upon. Since bed-wetting is mostly due to a developmental delay, the patient should also learn through targeted bladder training to take control of their own bladder.

Alternatively, an apparatus-based conditioning treatment is recommended, for example with the help of bell pants. This measure aims to wake up the child with a loud sound as soon as it wets itself. It should learn to pay attention to the signals from the bladder while sleeping and thus avoid bedwetting.

Another way to treat bedwetting is through drug therapy. The child is given a synthetically produced drug that is based on the body's own hormone vasopressin. This reduces urine production for about 8 hours at night.

The measures for treating bedwetting should definitely be determined together with a pediatrician so that they are also successful.

Outlook & forecast

The chances of a complete cure are usually very good with bed-wetting. Bed-wetting in children is in most cases a temporary phenomenon. Children suffer from wetting during the day or night. Usually the condition lasts for several months. Stress, restlessness, fear or a change in living conditions lead to an increase in symptoms.

If the psychological factors can be clarified, relief occurs. The children also learn to use their sphincter correctly with sufficient calm and patience. This usually leads to spontaneous healing that lasts permanently. However, if a relapse does occur in exceptional situations, it is rarely of long duration.

In some patients, wetting occurs in adulthood. There may be physical problems or illnesses that a doctor can treat. If the cause is mental disorders, healing may take some time. Nevertheless, there are also very good prospects for recovery here.

Recovery in old age is less optimistic. The older a patient is, the more likely it is that their sphincter will no longer work as usual. Despite treatment or therapy, a large number of patients remain bed-wetting until the end of their lives.

Aftercare

Bed-wetting usually goes away on its own. Statistically, a good 30 percent of all 5-year-olds still empty their bladder at night. Their number clearly decreases with age. A good one percent of adults are affected. The disease enuresis is unlike some people think nothing bad. Follow-up care aims to learn how to use it correctly.

The typical symptoms may reappear after they have disappeared for a long time. However, this so-called secondary enuresis occurs comparatively rarely. Once the bed-wetting has subsided, it is hardly likely that it will regain its strength. A doctor usually prescribes psychological therapy after the age of five.

A behavior and problem analysis have proven to be suitable. Restraint training can promote success. Stress and sleep disorders are considered to be the most important triggers. There are also drugs on the market that are designed to reduce the urge to urinate. However, its success is controversial.

If bed-wetting occurs again and again from time to time without it finally failing, those affected can relieve themselves. Washable blankets, diapers, pads and other things make life much easier. The enuresis does not lead to any further complications. It neither reduces the lifespan, nor is it a serious disease.

You can do that yourself

Bed-wetting can have various causes and the treatment steps can be correspondingly different. Bed-wetting as a result of alcohol consumption, a nightmare or stress, for example, can be counteracted by changing your lifestyle and sometimes by changing your environment. Talking to a therapist can help determine the underlying cause and fix it quickly.

If bed-wetting is caused by an illness or medication, you should first speak to the responsible doctor. In most cases, the nocturnal mishaps can be reduced or dealt with easier by changing the medication or by taking appropriate preventive measures (dietary measures, electronic alarm systems, incontinence underwear, etc.).

In the case of bedwetting in childhood, understanding and preventive measures are particularly recommended. For example, a night light or an easily accessible light switch in the hallway or toilet can help the child reach the toilet. A bedside potty near the bed can also reduce bedwetting. Protective covers and having fresh bed linen ready also help. Parents should also allow enough time in the morning so that the child can take care of themselves properly after an accident. In general, speak to the child and convey that bedwetting is not unusual and will go away on its own.