The Problems
Bedwetting
PROBLEMS ASSOCIATED WITH BEDWETTING -   
ASSOCIATIONS WITH DEVELOPMENT OF BLADDER CONTROL -   
ASSESSMENT AND MANAGEMENT - q
 

Bedwetting (enuresis) is very common. It is often ignored and passed off as something to "grow out of". It can cause a significant degree of stress to child and the family. About 80% of children have never had control for more than 12 months of their early childhood (primary nocturnal enuresis). The rest being known as secondary nocturnal enuresis.




Within the 5 to 10 year old age group in Australia,  100,000 to 150,000 children regularly wet the bed at night.

In primary school there will be several bed wetters in each class, and in secondary school at least one in each class.

It is more common in boys in earlier childhood than girls, but  this evens out in later childhood.
This has no consequence in the management of bedwetting, or the good results.

 

 

 

Most Children will grow out of it, however the question in when. About 15 - 20% cease wetting each year.
Some go on into adult life ( -1%).
 

 

  • Problems Associated with Bedwetting
  • Children Don't Like Bedwetting.
                                      They May:
    - Avoid social situations eg: sleepovers
    - Loose self confidence
    - Suffer name calling and teasing, particularly from siblings
    Child / Family Conflicts. - Especially if a parent believes it is within the child's control.
    - Extended family may place pressures on achieving control
    Anxiety / Guilt of Parents. - Not achieving "milestones"
    - Anxiety regarding lack of normality
    - Lowered self esteem as a parent
    Extra Work - Laundry.  Extra cleaning costs etc
    Toilet Accidents & Child Abuse. Cited as the second most common reason for child abuse

     

  • Associations with Development of Bladder Control

  • Family History / Genetics A family history is quite common.
    It's presence does not effect the rate of cure.
    Possibilities for an enuresis gene involved in primary nocturnal enuresis appears to in chromosome areas:
    13q, 12q, 8q, 20q, and 10q.

                             Risk to your Child
         If 1 parent used to wet the bed    - 35 - 40%
         Both parents used to wet the bed - 75 - 80%
    Bladder Capacity
    - "Small bladder"
    There is no evidence that a small or unstable bladder contributes to night time wetting.
    Wetting, however, is more likely to occur when the "functional bladder capacity" (i.e. the urge to go) maybe low.
    Urine Concentration Normally urine is concentrated at night with release of the hormone A.D.H. (anti-diuretic hormone). ADH "instructs" the kidneys to concentrate the urine, lowering the amount of urine produced.
    In many (not all - 2/3rds ), ADH production is not increased at night and children often then flood the bed.
    This does not explain why they do not wake up.
    Sleep and Arousal A complex issue.
    It is known that wetting occurs during all stages of sleep.
    Not all children are deeper sleepers, but wetting may relate more to moving between stages of sleep.

    Sleep Apnoea (stopping breathing) is associated with night time wetting.
    This is usually manifest by snoring, stopping breathing and restarting with a gasp. Large adenoids may be to blame.
    Social and Emotional Whilst in some children that wet, there may sometimes be associated emotional or behavioural problems, the association is not clear.
    Maturity Delayed maturity would account for the spontaneous cure rate, however as most children respond very rapidly to an alarm, this is less likely as a cause.
    Toilet Training Variable opinions exist.
    Attempts to train before 18 months may inhibit the normal processes of getting dry.
    There is also postulated a sensitive period for bladder training around the 3rd year of life. Stresses around this time may interfere with the chances of the dryness.
    Constipation Often associated with wetting.
    Possibly by giving confusing signals to the brain, or by "irritating the bladder".
    Medical Problems Uncommon - Must Exclude Structural problems / Infections
    Diet Caffeine can irritate the bladder
    Fluids Reducing fluids is of NO Help
    Increased fluids during the day is helpful
    ADHD Produces a higher frequency of Night Wetting

    The relationship of arousal to a full bladder -  increased night urine production and reduced bladder capacity (functional) seems to be at the basis of night wetting.  That is children need to wee at night but do not wake up to do it!

    Last Updated  Sunday, 01. May 2016


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