OOOPS!
Does your child have a bedwetting problem?
by Dr. Jack Cassell
PARENTGUIDE NEWS JANUARY 2006

Enuresis, or bedwetting, is a perfectly normal stage in every child’s physical development. You can ask any parent and they’ll tell you— babies wet the bed.

But it’s also expected that bedwetting problems will go away as a child gets older. If that fails to happen, that’s when professionals like me bolt into action.

In order to understand the mechanism behind bedwetting, it’s necessary to understand how we become continent in the first place. When a baby is 1 year old, he or she has no control of urine storage. Period. Once an infant’s bladder begins to stretch, it might not remain relaxed and could reflex contract, causing the child to void. This can happen day or night, during sleep or when the child is awake, because the nerves necessary to stop these reflex contractions aren’t working at that age. Once the nerves mature, the ability to control bladder storage will be possible— but not before. The mother who sits her unfortunate child on the toilet prior to nerve maturation is only training herself, having little to no effect on the child. When Mom successfully toilet trains Junior, it will be when the child’s body is ready, not just when the mother thinks it’s time.

A baby’s bladder is a completely uncontrolled muscle that will spontaneously contract once it fills to a certain volume. As discussed above, the nerves, which inhibit involuntary bladder contractions, are immature and remain inactive until age 2 or 3. Once the nerve cells grow their special covering— called the myelin sheath— they begin to conduct nerve impulses to the bladder. This is what suppresses any reflex bladder contractions in toddlers on up!

When bedwetting fails to resolve in a young child, we’re usually dealing with a behavioral problem that is readily correctable. According to the National Kidney Foundation, five to seven million children age 6 and over wet their beds. One treatment option parents have is to try putting the child to sleep at night on a blanket specially-made to sense the presence of liquid. These blankets are designed to trigger a noxious alarm at the moment the bedwetting occurs, waking up the child. This method has proven to be quite effective in the past to eradicate the unwanted behavior, helping to bring maturation lags up to snuff. Of course, you’ll also want to limit your child’s liquid intake prior to bedtime. Certain prescription medications are also used to treat enuresis, though I recommend parents exhaust all other options before resorting to child medication.

Careful review of medical history is necessary to identify any preexisting neurologic conditions that may be causing the problem. The nerves that inhibit reflex bladder contractions are almost always affected when generalized neurologic disease occurs. Is the child a really sound sleeper? Does the child drink a vast amount of fluid a few hours before bedtime? Are we only dealing with incontinence during the hours of sleep or does the child also have problems getting to the toilet in time during the day, as well? Satisfying these questions will more than likely provide a reasonable explanation for childhood bedwetting.

Prior to treating any child with negative reinforcement, it’s essential to first rule out the presence of a urinary tract infection or congenital birth defect that might produce incontinence. It is imperative that parents create a comfortable, stable and calm environment for their child during the bedwetting treatment process. Children need to understand that their bodies are their own responsibility and that it is ultimately up to them to resolve the problem (with help and support from Mom and Dad, of course). And be sure to always reward success! You’ll want to give your child positive feedback, and mark milestones (a full week of dry nights, for example) with some kind of special recognition— a reward or a treat.

It is important that, when dealing with a bedwetter, parents remember to avoid the inclination to yell and scream at the child in question in the hopes of making him or her stop. Recent studies have now clearly shown that this approach tends to fall short of the mark.

Nothing screws up a child more than a parent who doesn’t seem to understand what they are going through. A bedwetter is extremely vulnerable and it may not take more than a little perceived impatience to really complicate a potential solution to this problem. Why chance damaging your parent-child relationship at all?

Dr. Jack Cassell is a seasoned urologist, specializing in urological cancer, with more than 20 years experience. He is the author of Better Living Through Urology: 21st Century Solutions to Age-Old Problems (Acorn Publishing).