The word ‘enuresis’ comes from the Greek word meaning “to make water”.  In the United States the word has come to be associated with wetting at night (nocturnal enuresis), or “bed-wetting” during sleep, which is the most common, and during the daytime (diurnal enuresis).  Bed-wetting is fairly common among children and is often just a normal stage in their development.  It is more common in boys than in girls.  Enuresis is further divided into two classifications:  Primary, which refers to children who were never able to be trained to control urination; and, Secondary, which refers to children who have been successfully trained but, for some reason, regress back to wetting.  The term is usually reserved for describing repeated inability to control urination in children old enough to be reasonably expected to do so.

Children attain bladder control at varying ages.  By the second year of life children begin to develop the ability to voluntarily relax the muscles used to hold urine (continence) and begin voiding.  By around age four all children with normal functioning urinary systems have achieved this ability.  Typically, night time dryness most often follows achievement of daytime continence, and by the age of six the vast majority of kids no longer wet the bed.  Urinating during sleep up to the age of six is not unusual although clearly very frustrating to most parents.  So, if your child is younger than six years old it really is not necessary to be considering any sort of formal treatment for bed-wetting.

Several causative factors have been identified with regard to bed-wetting.  Some of the more common causes include:

• Stress
• Trouble waking up from sleep
• The central nervous system develops more slowly than normal
• Certain genetic factors, in that it does tend to run in families
• Urinary tract infections
• A small than normal bladder
• Certain and rather rare anomalies in the urinary system and spinal cord
• Rarely occurring hormonal problems

In the case of primary enuresis psychological (mental health) issues are almost exclusively the result of the disorder, not the cause of it.  However, in secondary enuresis, although still rather rare, psychological issues have been found to be a causative factor.  In reviewing a vast array of studies looking at the psychological impact of enuresis demonstrates a clear and considerable effect on both the child and their family.  Children suffering from enuresis are more often punished, and are at significantly increased risk of both emotional and physical abuse.  Studies further show a stark increase in frequency of behavioral problems in children with enuresis.  Children experience feelings of anxiety and embarrassment; school performance is typically negatively impacted; there is a loss of self-esteem; interpersonal relationships are negatively affected; and, there is an overall diminishment in the child’s quality of life.  Of note is the finding that even enuresis as infrequently as once per month has been demonstrated to have a negative impact on a child’s self-esteem.

As for treating bed-wetting, the good news is that the vast majority of children will outgrow their enuresis without the need for specific treatment intervention.  If, however, your child is one of those whose bet-wetting has not resolved there are several steps that can be taken to try and improve the situation.  There are two main types of effective treatment interventions available, behavior therapy and medication.  Some of the more commonly used behavioral treatments include:

• Limiting the amount of fluids consumed before bedtime
• Having the child use the bathroom at the beginning of their bedtime preparation routine, and then again just before actually going to sleep
• Creation of a system of rewards for nights without an episode of bed-wetting
• Use of a specialized alarm system which buzzes when the bed gets wet and awakens the child thereby helping teach them to respond to sleep-time bladder sensations
• Having the child be responsible for changing the wet bed sheets
• Having the child practice holding their urine for longer and longer times during the day (known as ‘bladder training’), in an attempt to actually stretch the bladder so it is capable of holding more urine.

If your child is seven years old or older, and if behavioral interventions are not successful, your child’s pediatrician may choose to give them medicine to help treat the enuresis.  Although the two main types of medication used are not a ‘cure’ for bed-wetting, they can be very effective when used in conjunction with behavioral interventions.  One type of medication helps the kidneys to produce less urine, and the other helps the bladder actually hold more urine.

So, what can you do to help your child cope with the challenges associated with enuresis?  Remembering that bed-wetting can often lead to behavioral problems as a result of feelings of embarrassment and guilt, your child should not be made to feel guilty about a problem that really is not their “fault” (in that it is not something they choose to do).  Yes, your child should be held responsible for their bed-wetting, but punishing them for it will do absolutely nothing to help solve the problem.  Covering their mattress in a waterproof cover will make clean-up easier, and praising your child for having done their best to not wet the bed, and for helping clean up, will help them cope more effectively on an emotional basis.  Placing nightlights in the hallway to the bathroom so that it is visible at night, and reminding your child that it is okay to go to the bathroom in the middle of the night, can go a long way in helping resolve the problem.  Finally, as enuresis tends to run in families, if indeed one of the parents also experienced it as a child, sharing that information can help them feel less ashamed, especially within the family system.