50Minutes - Simple Steps to Dry Nights: Effective ways to banish bedwetting

Nocturnal enuresis, more commonly known as bedwetting, is defined as an intermittent, unconscious and involuntary discharge of urine during sleep after the age of five. It is important to specify that this discharge of urine is not related to any medical, neurological or psychiatric illness.

While most children manage to stay dry during the daytime at the age of around three (although some accidents may still occur), after the age of five the child should have the sphincter control to stay dry both during the day and at night. Enuresis therefore occurs when the child still cannot control their bladder after the age of five.

In general, children stop wetting the bed by:

• around 18 months for 2% of boys and 6% of girls;
• around three years for 75% of boys and 80% of girls;
• around five years for 85 to 90% of children;
• around 15 years for 99% of children (Valleteau de Moulliac, Gallet and Chevalier, 2005).

Did you know?

Far more boys than girls are affected by enuresis (60%, Mas, J.-L., Figon, S. and Senez, B., 2004).

The frequency of enuresis varies considerably: it can be regular or irregular, intermittent with long periods of dryness, or episodic with occasional accidents. It can occur at the beginning of the night and be explained by a deep sleep which the child struggles to wake from and during which they do not feel the need to urinate, or it can appear in the early hours of the morning and be linked to a relative overfullness of the bladder.

Enuresis can be divided into two types depending on how it appears: primary and secondary enuresis.

80% of cases are primary enuresis, which means that the child has virtually never been dry at night and generally goes away by itself in time. However, if the problem persists after the normal toilet training age, it may be worth consulting a doctor, who will determine whether the enuresis is due to a specific physiological problem and requires medical treatment.

Secondary enuresis occurs when the child has been completely dry (day and night) for a period of six months to a year. In most cases, this regression results from an event which has caused an emotional shock for the child.

The causes of primary enuresis tend to be physiological, because the child has never managed to stay dry at night. Secondary enuresis, on the other hand, more often results from psychological causes, although the problem may still be physical.

Based on the childs medical history (established by asking questions) and possibly a urine analysis, the doctor will often identify a physiological problem, whether organic or functional, mainly in cases of nocturnal primary enuresis. The most common causes include:

• An immature bladder. The child is unable to control their urethral sphincter and hold their urine in when the need becomes pressing.
• An unusually small bladder. The bladder is too small to contain urine for a long period of time.
• An endocrine imbalance. In some children with enuresis, antidiuretic hormone (ADH) is not secreted correctly. This makes it difficult for the body to absorb liquid, which can result in nocturnal polyuria, a urinary problem characterised by an abnormally high need to urinate at night.
• Overly deep sleep. In this case, the child has a particularly high sleep threshold, which means that they struggle to wake up and remain asleep in spite of the signals their bladder is sending them.
• A genetic predisposition. Studies are currently underway to identify genes which could be linked to enuresis and to determine their exact role. In particular, chromosomes 8, 12, 13 and 22 may be involved.
• An underlying organic disorder. Sometimes, nocturnal enuresis is caused by a separate illness or infection, such as diabetes or a urinary tract infection. This particular organic cause can also apply to secondary enuresis.

Did you know?

If one parent suffered from enuresis, a child has a 44% chance of also being affected. This rises to 77% if both parents suffered from enuresis (Dehin, 2002).

As well as purely physiological factors, enuresis particularly secondary enuresis can be explained by a psychological cause, namely a significant event which has had a major effect on the childs daily balance. In this specific case, it is useful to isolate the moment in time when the bedwetting problems began. This bedwetting may result from:

• An emotional shock. Children who have been dry for a long time may sometimes regress following an event which distresses them, such as the divorce of their parents, the birth of a sibling, a death, a change of school, and so on.
• A form of rebellion. If the demands linked to toilet training were unsuited to the childs age or abilities, they may feel the need to express their unhappiness or distress by wetting the bed.
• A general sense of discontent. A child growing up in a hostile, violent, tyrannical or negligent environment may unconsciously express their discontent and fear through nocturnal enuresis.