Bedwetting occurs in about 15 to 20 percent of five-year-old children. Although common, enuresis causes concern for both the child and the parents. Fortunately, the problem improves over time, and each year about 15 percent of bedwetters will spontaneously stop bedwetting so that by age twelve, just 3 percent still wet the bed. Boys continue to have bedwetting at older ages than girls by a margin of 3:1.
What Causes Bedwetting?
Medical causes of enuresis are rare. For most cases, there is no identifiable cause; however, there may be a familial component. If a child’s parent or sibling experienced bedwetting, the child has an increased risk of bedwetting also. Parents worry that there may be something medically wrong with their child like diabetes or a urinary tract infection; while this can cause enuresis, it is rarely the reason the child wets the bed.
The process by which children learn to stay dry at night is somewhat complicated. The child’s brain must tell the child’s bladder to retain the urine even if the bladder is full. The brain must then awaken the child so that he can go to the bathroom rather than just permit the bladder to release the urine into the bed. It appears that the signal to awaken may not be as strong in children with enuresis as in those who do not have this problem. Often parents describe their child as a “deep sleeper.”
Children who have never been consistently dry at night for three consecutive months have primary nocturnal enuresis. Medical causes for primary nocturnal enuresis are uncommon. Children who have been dry and start to wet have secondary nocturnal enuresis. Medical causes are more common in these cases, but still uncommon. If secondary nocturnal enuresis occurs, it should be discussed with the child’s doctor. Some non-medical causes can be the stress of a new baby in the family, difficulty in school, or worries about family problems.
Children typically urinate more frequently than every four hours and more than four times a day. Children who are toileting less frequently or who are bothered by constipation (having hard and infrequent bowel movements—less than once every two days) have a higher risk for bedwetting. Constipation contributes to bedwetting because that stool backed up in the intestine can place pressure on the bladder leading to more frequent bedwetting. One of the first steps in helping a child with bedwetting is to help them develop more frequent toileting habits and to resolve the constipation.
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