Incontinence

Updated 18 July 2016

Bedwetting stems from physical causes, not psychological

Even though science has long understood that bedwetting is a physical, not psychological, condition, harsh stigmas still surround bedwetting persist.

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When an older child wets the bed, much more is at stake than soiled sheets. In fact, in a recent surveys only 38 percent of parents knew that bedwetting stems from physical causes.

The problem lies in the nervous system

"The issue has been 'Oh, these kids are lazy and they're not getting up.' That's really not at all the case," explained Dr Marc Cendron, a professor of urology at Harvard University.

"What's happening is that these kids just have a nervous system that doesn't allow them to integrate the information that's sent up to the brain by the bladder and act on it," he said.

Urologists estimate that between 10 percent and 15 percent of children aged six and seven wet the bed on a regular basis.

However, Cendron explained, as children's bodies mature, that number falls by about half each year, until only about one percent to two percent of kids continue to wet the bed by age 14 or 15.

Other theories debunked

In the mid-20th century, psychologists and paediatricians theorised bedwetting might be rooted in underlying stress or "acting out." That theory has long since been discounted.

"It's definitely a neurologic issue," Cendron said.

"What happens is that our bladder works rather independently of the brain when we're babies," he added.

For most children, brain-bladder neurological connections will mature with age, letting the brain receive signals that tell it when the bladder is full and when voiding is appropriate.

Those connections simply mature later in kids affected with bedwetting, Cendron said.

The message has to be carried across

Unfortunately, that message hasn't been getting through to the public, according to Amy Dunlop, a paediatric nurse practitioner in Illinois.

In the parent survey, sponsored by the American National Association of Nurse Practitioners, a full 26 percent of parents said they believed bedwetting had psychological roots.

"The general public still understands this to be a mental health problem," Dunlop said. "So a lot of education needs to be done to teach parents that it's not the kid's fault, they're not doing it deliberately."

She said bedwetting - known in medical parlance as nocturnal enuresis - can be controlled, often by simple changes in daily drinking and voiding behaviour.

"Many school-age kids do not drink fluids during the day," she pointed out. At the same time, they often avoid using dirty, crowded school washrooms.

"So these kids go all day without voiding or drinking until they get home," she said. Thirsty upon their return home, these children then consume large quantities of liquids in the hours before bedtime.

What will help?

Encouraging kids to drink and use the bathroom during school hours can help diminish bedwetting over time, Dunlop explained.

Medical treatments are also available. Most effective is behavioural change therapy involving a moisture-sensitive alarm that goes off when sleep-time urination occurs.

"The basis of this therapy is essentially a conditioned response to the stimulus," Cendron said. "It takes a few months; it's a long-term therapy, and it's quite effective. The research shows that it works in 50 percent to 80 percent of cases."

Alarm therapy takes a real commitment from parents, however. "You have to remember that if a child is eight years old, he's been wetting the bed for eight years," Dunlop said. "It's going to take more than a week to correct this problem."

Medications also exist that work by either reducing the amount of urine produced by the kidneys or enlarging the bladder's holding capacity. These drugs have good track records in controlling bedwetting, with few side effects, Cendron said.

The emotional toll considered

Still, it's the emotional toll of bedwetting that is of greatest concern to kids affected by the condition.

"It's not just the teasing," Cendron said. "It's the parental response, the disapproval, the punishment - there's reports of physical abuse of kids who wet the bed because of the level of frustration that it causes. And it's a well-documented fact in the psychological literature that kids with bedwetting suffer from reduced self-esteem."

Parents can best help a child deal with bedwetting by offering compassion and support.

"They should make the child understand that it is not his or her fault," Cendron advised. "And then they should seek out medical advice."/p>

Dunlop agreed. "This is a fixable problem," she said. "They are not alone." – (HealthDayNews)

Read more:

Child Zone
Effective treatments for bedwetting

 

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Prenevin Govender completed his MBChB at the University of Cape Town in 2001. He obtained his Fellowship of the College of Urologists in 2009 and graduated with distinction for a Masters in Medicine from the University of Cape Town in 2010. His special interests include laparoscopic, pelvic organ prolapse and urinary incontinence surgery. He consults full-time at Life Kingsbury Hospital in Claremont.

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