Author: Dr. William Rappaport
Date: May 2017
Bed Wetting: What is it? What can be done to help the child?
Families who have children older than five who wet their bed or eliminate during the day are often concerned something is seriously wrong with their child. In fact the opposite is true. Love, compassion, behavior modification and psychotherapy can do wonders for a child who suffers this humiliating disturbance in life.
To make a diagnosis of enuresis, bed wetting, a child must have reached the chronological or developmental age of five. It must take place at least twice a week for three months or cause significant distress and interfere with the child's school and/or social life.
There are two main types of enuresis in children. Primary enuresis occurs when a child has never established bladder control. Secondary enuresis occurs when a person has established bladder control for a period of six months, then relapses and begins wetting. Involuntary enuresis is much more common than voluntary enuresis.
Primary enuresis occurs when young children lack bladder control from infancy. Most of these children have urine control problems only during sleep. It is unconscious and non-intentional. These children do not wake up in time to relieve themselves. In other cases, the child's enuresis may be related to a sleep disorder.
Children with secondary- diurnal enuresis wet only during the day. They have difficulty controlling the urge to urinate or delay urinating until they lose control. Some children have both diurnal and nocturnal enuresis.
Researchers have found that primary enuresis is more likely to occur after a child has experienced a stressful life event such as the birth of a sibling, divorce or death of a parent, or moving to a new house. Primary nocturnal enuresis is not caused by psychological disorders. Bed-wetting runs in families and there is strong evidence of a genetic component to involuntary enuresis.
Behavior modification is often the treatment of choice for primary enuresis.
- Restricting liquids starting several hours before bedtime
- Waking the child up in the night to use the bathroom
- Teaching urinary retention techniques
- Giving the child positive reinforcement for dry nights and being sympathetic and understanding about wet nights
Secondary enuresis is often treated with psychotherapy. The goal of the treatment is to resolve the underlying stressful event that has caused a relapse into bed-wetting. Unlike children with involuntary enuresis, children who intentionally urinate in inappropriate places often have other serious psychiatric disorders. Enuresis is usually a symptom of another disorder. Therapy to treat the underlying disorder is essential to resolving the enuresis.