Enuresis (bed wetting)

Enuresis, or bed wetting, is a common childhood problem. Between 5% and 17% of all children have problems with bed wetting. Boys are more likely to have problems with enuresis than girls. Individual children vary greatly, but most children have developed bladder control by the time they are 4 or 5 years old. Enuresis usually stops by the time children reach 6 to 8 years old.

Bed wetting is an usually an involuntary action that happens while the child is asleep. There are many factors that can contribute to the development of enuresis. Physical and organic causes of enuresis include slow development, small bladder capacity, urinary tract infections and symptoms related to other medical disorders. Genetics may also be a factor. Children who have a family member with a history of enuresis are more likely to have problems with bed wetting themselves.

Differences in individual temperament, toilet training methods, family environment, and stress may also affect the development of enuresis. It is very important to first rule out possible physical and medical factors before deciding how to deal with a child who has enuresis. If problems with bed wetting continue or cause significant distress, parents should consult a physician for additional help.

The Diagnostic and Statistical Manual of Mental Disorders is used by physicians to diagnose enuresis. It defines enuresis as:

1. repeated voiding of urine into bed or clothes
2. occurring at least twice a week for at least three months or causing significant distress in social, academic or other important areas of functioning
3. the individual must be at least five years of age
4. voiding is not due to a general medical condition or a medication

Some things that may help parents deal with bed wetting include:

• Do not scold, shame, threaten, or punish the child. It will damage the child's self esteem and he or she probably feels bad enough already.
• Encourage the child to be responsible for cleaning him or her self, clothing and bed linens.
• Consider using a behavior modification program. Praise "dry nights" and give positive reinforcements. Allow the child to earn rewards for "dry nights".
• Reduce fluid intake just before bedtime. Make sure the child urinates right before bed time. Wake the child up later to use the bathroom (such as just before parents go to bed).
• Consider buying a alarm that wakes the child at the first sign of urination.
• Bladder retention training (encouraging child to postpone urination as long as possible after fluid intake) may help child become aware of bladder fullness and increase bladder capacity. Drug therapy may be helpful for some children.

For more information on enuresis, or other questions or comments, call the Trinity Adolescent Program at (515) 574-6596.

This article was written by Pam Lehman, a counselor with the Trinity Recovery Center at Trinity Regional Hospital. Pam has a Master of Science degree in counseling.