Diseases

Bedwetting (Enuresis) – Causes, Symptoms & Treatment

Bettnässen (Enuresis)

Bedwetting , enuresis or enuresis are terms for a childhood disease in which children and young people do not yet have the natural urge to urinate under control. They usually wet themselves at night without realizing it. Bedwetting can have both psychological and physical (hormone balance) causes and should be examined and treated by a pediatrician. Under no circumstances should children be punished for bedwetting, as this usually only worsens the condition. Parents, child and doctor should work together to stop bedwetting.

What is bedwetting?

Pathological bedwetting, bedwetting or enuresis is when a child aged five years or older wets the bed regularly during the day or at night. The duration of wetting varies from case to case. In about one percent of those affected, the problem persists into adulthood.

In this disease, a distinction is made between primary bedwetting and secondary bedwetting. One speaks of primary bedwetting when a child has never been dry for a long period of time since birth. If there have already been dry periods of at least six months and the child wets the bed again afterwards, this is referred to as secondary bedwetting. However, primary bedwetting is much more common.

causes

The specific causes of primary bedwetting have not been clearly clarified. Presumably, several factors play a role, with psychological problems being of little importance in this form. Experts agree that primary bedwetting is a developmental delay in children.

Affected children do not feel when their bladder is full. The control mechanisms that control bladder emptying have yet to be fully developed. It is possible that this form of bedwetting is also inherited, as there are families in which this problem occurs frequently.

Some research shows that many enuresis patients do not produce enough of the hormone vasopressin. This hormone controls the water balance in the body. If there is enough, less urine is formed during the night, so that you hardly have to go to the toilet at night or not at all.

The main causes of secondary bedwetting are usually psychological problems or sudden changes in the child’s environment. Bedwetting occurs particularly frequently, for example, when a family member is lost, the parents separate, or an impending change of location.

Symptoms, Ailments & Signs

Bedwetting manifests itself primarily through the unintentional loss of urine (usually while sleeping in bed). This symptom has only a limited disease value. For example, it is normal for children up to about the age of three or four to wet their bed. This can occasionally still happen later.

Primary enuresis is referred to when prolonged bedwetting is viewed as a developmental disorder. The symptoms here are bedwetting, deep sleep and polyuria . Abnormalities with regard to the hormone ADH and any accompanying psychological symptoms can also be identified diagnostically.

Those affected notice their bedwetting by the next morning at the latest. However, it can also happen that those affected wake up as a result. The definition of enuresis serves to differentiate from mild continence disorders: It is characterized by the complete discharge of the bladder contents, while incontinence can also mean not losing any amounts of urine.

Secondary enuresis, on the other hand, means that unwanted urination occurs at the earliest after a dry phase that lasts six months. This is also often associated with psychiatric symptoms, frequent urinary refusal (squeezing the legs and similar behavior) and a disturbed voiding pattern. In this context, there is also situation-dependent incontinence – for example when laughing or coughing .

Course & Prevention

The causes of bedwetting make it clear that a child does not wet the bed intentionally. In most cases, those affected are even highly motivated to get rid of bedwetting quickly and permanently. Therefore, parents must not blame themselves or the child under any circumstances. Punishments should also be avoided as they put additional pressure on the child. Rather, a treat helps with every dry night.

It has proven useful for the child to record on a calendar for at least two weeks whether it was dry (sun) or wet (cloud). This measure alone often leads to success, as the children gain self-confidence and stop bedwetting.

You should also make sure that the child does not drink large amounts of liquid before going to sleep. Caffeinated beverages in particular stimulate urine production and encourage bedwetting.

If the child continues to wet despite a lot of patience and good encouragement, an experienced specialist should be consulted. He knows best which individual treatment is most suitable for a child. If a child wets the bed due to psychological problems (secondary bedwetting), these should be dealt with as quickly as possible.

complications

Bedwetting often leads to social complications. Children suffering from nocturnal enuresis often cannot sleep with other children. They are also often disadvantaged on school trips. Sometimes the children or parents avoid such opportunities, which can affect the child’s social status within the group.

Even if the child participates in such sleepovers, bedwetting is often associated with shame and guilt. Fear and despondency, even to the point of depression, are often present. Depression can develop fully in childhood. The clinical picture is characterized by a depressive mood and the loss of joy and interest.

Other psychological problems such as hyperactivity are also possible. It depends on the individual case whether bedwetting is the cause, consequence or side effect of another mental illness. The social complications are often greatest in enuresis diurna. Accordingly, the psychological stress on the child increases if it also wets itself during the day.

In addition, psychological bedwetting is more common in children who suffer from abuse or neglect. This can lead to further complications, such as post-traumatic stress disorder (PTSD), behavioral problems, and anxiety, obsessive-compulsive, and eating disorders .

Complications arising from treatment are very rare. Empathetic doctors and therapists can often help children overcome feelings of shame.

When should you go to the doctor?

If a child occasionally wets the bed, this can have completely harmless triggers, such as very deep sleep. A visit to the doctor is then unnecessary. However, if this behavior occurs frequently, the causes should be clarified by a doctor. In any case, a doctor should be consulted if bedwetting occurs together with other symptoms.

In particular, if the child complains of pain when urinating or frequent urges to urinate, there is a suspicion of a urinary tract infection. When children wet themselves during the day, the reason for this is often a bladder dysfunction that needs to be treated by a doctor. Signs of urinary incontinence are constant clenching of the legs, leakage of urine when laughing or coughing, and very frequent urination with normal drinking habits.

If there is blood in the urine or if the child complains of severe pain, you should go to the nearest hospital immediately. In these cases, these may be symptoms of a serious bladder or kidney infection.

A doctor’s visit is also advisable if the child was already dry and starts to wet the bed again after a long time. If no physical causes for bedwetting can be identified, a child psychologist should be consulted in addition to a doctor.

Treatment & Therapy

For the treatment of primary bedwetting, there are basically 3 approaches with the aim of eliminating bedwetting completely and permanently. Child psychologists in particular recommend behavioral therapy . Among other things, the drinking behavior of the children should be recorded and reflected upon. Since bedwetting is usually due to a developmental delay, the patient should also learn to take control of their own bladder through targeted bladder training.

Alternatively, an apparatus-based conditioning treatment is recommended, for example using a pair of bell-shaped trousers. This measure is aimed at waking the child up with a loud sound as soon as it wets. It should learn to pay attention to the signals of the bladder while sleeping and thus avoid bedwetting.

Another way to treat bedwetting is drug therapy. Here, the child is administered a synthetically manufactured drug, which is based on the body’s own hormone vasopressin. This reduces urine formation at night for about 8 hours.

The measures to treat bedwetting should definitely be determined together with a pediatrician so that they are successful.

Outlook & Forecast

The chances of complete recovery from bedwetting are usually very good. In most cases, bedwetting in children is temporary. Children experience bedwetting during the day or at night. The condition usually lasts for several months. Stress, restlessness, fear or a change in living conditions lead to an increase in symptoms.

If the psychological factors can be clarified, relief occurs. With enough rest and patience, the children also learn to use their sphincter properly. This usually leads to spontaneous healing that lasts permanently. However, if a relapse occurs in exceptional situations, it rarely lasts for a long time.

Bedwetting occurs in adulthood in some patients. There may be physical problems or illnesses that are easily treatable by a doctor. If the cause is a mental disorder, it can take some time to heal. Nevertheless, there are very good prospects for recovery here as well.

Recovery in old age is less optimistic. The older a patient is, the more likely it is that their sphincter will no longer function as usual. Despite treatment or therapy, bedwetting persists in a large number of patients until the end of their lives.

aftercare

Bedwetting usually goes away on its own. Statistically, a good 30 percent of all 5-year-olds still empty their bladder at night. With increasing age, their number decreases significantly. About one percent of adults are affected. The disease enuresis is different than some people mean nothing bad. Aftercare aims to learn how to handle it properly.

The typical symptoms can reappear after they have disappeared for a long time. However, this so-called secondary enuresis is comparatively rare. Once the bedwetting has subsided, a resurgence is unlikely. A doctor usually prescribes psychological therapy after the age of five.

A behavior and problem analysis have proven to be suitable. Restraint training can promote success. Stress and sleep disorders are considered to be the most important triggers. There are also drugs on the market that are designed to reduce the urge to urinate. However, its success is controversial.

If the bedwetting occurs again and again from time to time without finally stopping, those affected can relieve themselves. Washable blankets, diapers, pads and other things make life much easier. The enuresis does not lead to any further complications. It does not reduce lifespan, nor is it a serious condition.

You can do that yourself

Bedwetting can have a variety of causes and the treatment steps can vary accordingly. Bedwetting as a result of alcohol consumption, a nightmare or stress , for example, can be counteracted by changing your lifestyle and sometimes also by changing the environment. Talking to a therapist can help identify the underlying cause and address it quickly.

If bedwetting is caused by an illness or medication, you should first talk to your doctor. In most cases, nocturnal mishaps can be reduced or dealt with by changing the medication or taking appropriate preventive measures (dietary measures, electronic alarm systems, incontinence underwear , etc.).

When it comes to bedwetting in childhood, understanding and preventive measures are recommended. For example, a night light or an easily accessible light switch in the hallway or toilet can help the child reach the toilet. A chamber potty near the bed can also reduce bedwetting. Protective covers and the provision of fresh bed linen also help. Parents should also plan enough time in the morning so that the child can be properly groomed after a mishap. The general rule is: talk to the child and convey that bedwetting is not uncommon and will go away on its own.

Lisa Newlon
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Hello! I am Lisa Newlon, and I am a medical writer and researcher with over 10 years of experience in the healthcare industry. I have a Master’s degree in Medicine, and my deep understanding of medical terminology, practices, and procedures has made me a trusted source of information in the medical world.