Bedwetting in children
Uncontrolled urination in children aged 4-5 years is professionally referred to as enuresis or urinary incontinence . After the age of 5, 15-20% of children occasionally leak urine, after the age of 7, about 10% of children and after the age of 10, about 3% of children, of which two thirds of children urinate only at night ( nocturnal bedwetting , Latin enuresis nocturna ). Bedwetting occurs more often in boys.
What are the causes of bedwetting?
Controlling bladder emptying is a complex process. Children usually learn to hold their urine before the age of 4, but some children take longer. Even in older children, “accidents” occur quite often, which are mostly connected to external disturbing stimuli. This so-called secondary enuresis can occur in already “dry” children, especially when the child is very upset or as a result of significant changes in his life. If the doctor excludes functional and organic causes of bedwetting , this phenomenon should not be considered a disease, but rather a difficulty that the child can unlearn. Bedwetting sometimes occurs in different generations of the same family; therefore, experts assume that it may be somewhat hereditary.
What symptoms can occur?
In general, a distinction is made between daytime enuresis (enuresis diurna) and nighttime enuresis (enuresis nocturna) , while of course there are also combined forms. Experts further distinguish between primary enuresis , when the child has not yet reached the developmental period in which he would be permanently continent (“dry”), and secondary enuresis , when the child begins to urinate again after at least six months of being out of diapers.
How is the diagnosis made?
The pediatrician will assess the family burden, the conditions in which the child grows up, any other diseases, and last but not least, the child’s psychomotor development to date. Psychological tests can help reveal some causes of bedwetting . Complicated sibling relationships, conflicts between parents, etc., and the subsequent individual reaction of the child to these stressful situations can also play a role.
Bedwetting usually has no physical cause. In the case of daytime urination, it is necessary to undergo a physical examination, urine examination, ultrasound examination of the kidneys and urinary tract . In addition, the doctor will ask the parents to keep a so-called “drinking and voiding diary” for the child, in which for 2-3 days they will write down when and how much liquid the child drank, and especially when and how much urine was passed (day and night). If a more serious disease is suspected or if the findings are unclear, additional examinations may be performed, e.g. using an X-ray or cystoscopy .
Note: There is no need to treat bedwetting in children under 5 years of age and in children who urinate no more than 1x to 2x a week. An important prerequisite for successful treatment is that the child wants to stay dry at night.
How is bedwetting treated?
A simple and relatively effective method of treatment is a special bed mat that triggers an acoustic signal as soon as the child urinates. However, before putting the child to sleep, it is necessary to attach the sensor intended for this to the sheet or to the child’s pyjamas. Every time the alarm goes off, the child gets a “learning opportunity”: he wakes up and learns how to stop the spontaneous leakage of urine – and can go to the toilet if necessary. This is a learning process, so no immediate results can be expected. The first successes usually come only after a few weeks of using the alarm. Czech experts recommend using the alarm for 3-5 months [1].
Parents should keep a simple diary even if the alarm is used (in the sense of “Did the child urinate?” / “Did the alarm go off?”). If the treatment is not successful even after six weeks of using the alarm, it should be discontinued and medical treatment with desmopressin can be started after consulting a doctor . If necessary (i.e. only if nocturnal enuresis reappears), after 4-6 months the alarm treatment can be tried again.
The prognosis for bedwetting is good. In many cases, this problem will go away on its own over time. Only 1% of children suffering from nocturnal enuresis will persist into adulthood. In the case of daytime enuresis, success depends on the treatment of the underlying disease.
Who can I contact?
You should visit a pediatrician or a specialist (pediatric urologist ), especially if the child has significant difficulties during the day (strong urge to urinate, which may or may not be accompanied by urination during the day). In the case of bedwetting, the best advice will be from a pediatrician, sometimes even a psychologist or psychotherapist can help
