Bedwetting

Bedwetting (nocturnal enuresis or 'sleepwetting') is involuntary urination while sleeping. It is normal in infancy, but can be a source of embarrassment when it persists into school age or the teen years.

 

Primary enuresis is when the child has never been dry at night or would not sleep dry without being taken to the toilet by another person, or has some dry nights but continues to average at least two wet nights a week with no long periods of dryness. Secondary enuresis occurs when a child goes through an extended period of dryness and begins to experience night-time wetting again. Secondary enuresis is often (though by no means always) caused by emotional stress.

 

 

Regulation and individual differences

 

Children usually achieve night-time dryness by developing one or both of two abilities. There appear to be some hereditary factors in how and when these develop:

  • A hormone cycle in which a minute burst of antidiuretic hormone happens daily at about sunset, reducing kidney output of urine well into the night so the bladder does not get full until morning. This hormone cycle is not present at birth. Many children develop it between the ages of two and six, others between six and the end of puberty, and some not at all.
  • The ability to awaken before sleep-wetting. For some children this is a natural extension of learning to be aware of and control their bladders while awake. For others, a variety of factors suppress or disrupt this awareness when asleep, and they are unlikely to develop it. Taking children to use the toilet while not fully awake can prolong dependence on that by encouraging them to urinate while nearly asleep.

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Prevalence

 

Figures commonly cited suggest that enough children sleep-wet at age six (perhaps one in three) so that it is within normal expectations. Because of this, supportive management can be seen as appropriate until a child is seven or eight or has the maturity and desire to take an active role in planning and implementing specific treatment. Also, even with no active treatment, about 15% (one in seven) of children who do sleep-wet will stop each year through natural development. Some sources indicate that 5-10% of teenage children experience occasional sleep-wetting.

 

 

Conventional treatment

 

Some psychologists and experts recommend the use of night-time training devices such as a bedwetting alarm to help condition the child first to wake up at the sensation of moisture and then at the sensation of a full bladder. Success with alarms is increased and relapses reduced when combined with programs which may include bladder muscle exercises, dietary changes, mental imagery, stress reduction, and other supportive activities.

 

Using absorbent products such as padded night-time pants usually helps bedwetting children feel less embarrassed about their accidents. Although these products will not treat or cure bedwetting, they make it easier for children and their families to deal with the issue.

 

The use of disposable training pants without any other treatment is not considered unusual until about six to 10 years of age. After that point, other treatments may be used with or without absorbent products, such as the aforementioned medication or alarm systems. Occasional bedwetting (such as once a month to once a year) is normal for a child aged between four and 16 and is nothing to get alarmed at.

 

There are, however, a growing number of voices against the use of such products, because some parents feel that they can hinder, rather than help the process of assisting with bedwetting; since some children appear to treat them and indeed use them, as a substitute nappy.

 

Experts generally agree that parents' understanding that sleep-wetting is not the child's fault strongly increases the child's willingness to help deal with it. Although historically, physical punishment such as spanking was the normal method of motivating older children to stop sleep wetting, anti-spanking advocates have discouraged any corporal punishment for this purpose.

 

Punishments including restrictions, teasing, or shaming, whether actual or threatened, are counter-productive. The child should be encouraged and self-reliance supported to allow for their own natural and native development to acquire the ability to sleep dry on their own terms.

 

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Our approach

 

Over 20 years of clinical practice, we have had clinical success with a combination of the following approaches with children who have been assessed by their treating physician as being a suitable candidate for such interventions:

  • Hypnosis is a gentle, safe and highly effective first approach that we will often offer
  • Relaxation, anxiety and stress reduction strategies
  • Cognitive Behaviour Therapy to address distressing beliefs, shame or stress
  • For the late maturing bladder, biofeedback may be appropriate

We can also help parents or carers to set up for success and decide on realistic regimes and time frames. Suitable candidates include children over seven years of age, children who regress to bed wetting after an emotional disturbance or when there is a family history of bed wetting.

 

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