A child can ask questions that a wise man cannot answer.  ~Author Unknown

Today I would like to talk about a troubling condition for parents and children alike.  It is called enuresis which is unintentional bladder relief or wetting the bed while asleep.  If you have a little one, aged 3-5, bed-wetting is considered normal and nothing to be concerned about. Usually, the bladder is regulated by a reflex that controls the sphincter and pelvic muscles preventing unwanted urination. More than likely,  bed-wetting occurs because your child has not yet learned to use this reflex.  This is known as primary bed-wetting. If however your little tyke  has learned to control this reflex, and after a few months reverts to this behavior again, it is called secondary enuresis.

If you have concerns about this behavior you should consult your pediatrician. He/she  will have to determine the type of enuresis it is, if it is secondary, there may be underlying emotional or physical problems. After taking a thorough history of potty training methods, sleeping patterns,  delivery complications, if any, your child's weight at birth, and other things that you feel are significant as well as a physical examination, a determination will be made as to the course of treatment to take.

I will briefly talk about physical causes of bed-wetting.
  • Genetic factors, if one parent had enuresis, there is a 45% chance that the child will be a bed-wetter, if both parents suffered from this condition there is a 75% chance of the child inheriting this problem. This happens because there is not enough of an anti-diuretic hormone (ADH) produced during sleep.
  • Bladder size may be a cause of bed-wetting.  If the child's bladder is unusually small, he/she may have a problem holding his water and may have to urinate more frequently.
  • Obstructive Uropathy or an abnormality in the structure of the ureter may cause your child to wet his/her pants during the day or night. Consequently, the bladder is unable to hold a normal amount of water and makes the child less able to control his/her urine.
  • Urinary Tract Infection or UTI if your child is complaining of burning or pain while going to the bathroom.
  • Tonsillar Obstruction if your child breathes through the mouth or snores and is groggy and grumpy in the morning.
  • Diabetes may be another physical cause of bed-wetting.
After your pediatrician has ruled out the above conditions, you may want to look at some psychological factors, and possibly take him/her to a mental health therapist or counselor for help.

Usually psychological problems are the cause of secondary enuresis.  Please continue reading. 
  • Stress is an important factor to consider especially if your child has been dry for a long period of time and suddenly begins soiling the bed at night.  Has he/she experienced something traumatic like the death of a loved one, even a pet. Is there a new baby in the house? Have you moved to a new neighborhood so that your child has to go to a new school.  How well is he/she doing at school, has the teacher noticed any changes? Are you having marital problems, or have you been recently divorced?
  • Toilet training is a very emotional time, if parents are too harsh, or too lax in their training, a child may revert to bed-wetting. As a parent, do you expect too much of your child, if so he/she may soil themselves. If you were too permissive in your training, perhaps beginning toilet training when your child was older, he/she may have poor impulse control.
  • Impulse Inhibition can cause bed-wetting. Is your child able to control his anger? How does he/she act when angry? By not allowing a tyke to express anger often causes daytime incontinence, but may be a factor in bed-wetting. It is not mentally healthy to suppress feelings of anger, grief, rage, etc for adults, let alone children.
  • Secondary Gain There are times when a child wants to get back at a parent (usually the mother) and will wet themselves without even being aware that they are doing it. Ask yourself these questions: What does the child get out of this behavior?  How do you as a parent react to this? How do siblings react? Is the child embarrassed wetting the bed? If your little one is not concerned about this problem, he may deriving some satisfaction from it and it will be more difficult to treat. But with patience, kindness and understanding this condition is curable.
I think that this is enough for now.  Come back for my next blog which will deal with various types of treatment  for bed-wetting in children, from counseling to alternative remedies.


References

Pediatrics for Parents, May, 1989, v10, n5, p6(2), Pediatrics for
Parents 1989,
Patient Care, Jan 15, 1985, v19, p75(7), Patient Care Communications
Inc. 1985,
Patient Care, Nov 30, 1984, v18, p54(15), Patient Care
Communications Inc. 1984,