Important Bedwetting Facts
The medical term for bedwetting is “enuresis,” which refers to bedwetting that is not due to an abnormality of any portion of the urinary tract. Primary enuresis means the child has never been dry, whereas secondary enuresis is the term used for a child who has previously been dry, but then starts wetting his bed. Bedwetting is sometimes referred to as “nocturnal enuresis” or “nightwetting.” Sometimes it’s called “sleep wetting,” since some children may also “nap wet.” Bedwetting really should be called “sleep wetting” because it occurs during sleep. Bedwetting is not an emotional or psychological problem, nor does it reflect a dysfunctional family. It is a problem of sleeping too deeply to be aware of bladder function.
Here are some bedwetting facts that every parent should know:
- 15% of five-year-olds, or around 3-4 children in a first grade class, are not dry every night.
- 85% of children eventually outgrow bedwetting without treatment.
- In the teenage years, only 2%-5% of children continue to wet their bed.
- Bedwetting boys outnumber girls by a ratio of 4 to 1.
The Genetics of Bedwetting
The genetics of bedwetting are similar to that of obesity. If both parents were bedwetters, the child has a seventy percent chance of being a bedwetter. If only one parent experienced sleep wetting, the child will have a forty percent chance of following his parent’s nocturnal habit. Often when children find out that other family members wet the bed, they feel less embarrassed about the condition. A small number of children have small bladders that are more easily overfilled, which could lead to sleep wetting!
It helps to first understand how children usually achieve bladder control. In early infancy, bladder-emptying occurs mostly by the bladder- emptying reflex. When the bladder reaches a certain fullness and the muscle has stretched to a certain point, these muscles automatically squeeze to empty the bladder. Sometime between 18 months and 2½ years, most children have an awareness of bladder fullness, the first step toward bladder control. Next, the child becomes aware that he can consciously inhibit the bladder-emptying reflex and hold in his urine. As a result of his urine-holding efforts, his bladder stretches and its capacity increases. When the child can consciously inhibit the bladder-emptying reflex, he achieves daytime bladder control. Nighttime control occurs when the child can unconsciously inhibit the bladder-emptying reflex.
Think of bedwetting as a communication problem: the bladder and the brain don’t communicate during sleep. The bedwetting child literally sleeps through his bladder signals. Delay in bladder control can occur if there is a delay in awareness of bladder fullness, a small bladder, or the bladder-emptying reflex continues to be strong well into later childhood. These components of bladder maturity occur at different ages in different children. Bedwetting is simply a developmental lag in the mastering of a bodily skill. There are late walkers, late talkers, and late dry-nighters.
Normally, bladder fullness works like supply and demand. The bladder fills with just enough urine at night so that it does not overfill and demand to be emptied. Bedwetters may overfill their bladder so the supply outweighs the demand, but because they are sleeping so soundly they just don’t tune into their bladder fullness.
Bedwetting is a Sleep Issue
Understand that bedwetting is a sleep issue. It’s not a behavioral issue, but rather a developmental one. Some children sleep so deeply that they sleep right through their “get up and go” bladder signals. New insights into the cause of bedwetting validate what observant parents have long noted: “He sleeps so deeply, he doesn’t even know he’s wetting the bed.” These deep sleepers are not aware of their bladder sensation at night, let alone how to control it. In addition to bedwetters sleeping differently, the hormonal control of urination may act differently in some children.
Some bedwetters may have a deficiency of ADH (anti-diuretic hormone), the hormone that is released during sleep and concentrates the urine so that the kidneys produce less of it during sleep and the bladder doesn’t overfill. This is something that can be discussed more with your doctor. There are medical treatments for ADH deficiency.
Tips and Advice
Parents with a child experiencing nighttime wetting can feel confused, frustrated and isolated – it’s not a topic many people talk about. That’s why it’s so important to talk to your pediatrician and include your child in this discussion. When kids hear from their parents and pediatricians that they are not alone, it instills greater confidence and understanding about the condition. In the meantime, the best thing you can do for your child is to ease the stress of bedwetting by making them feel comfortable and letting them know you’re not upset or disappointed.