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Wetting The Bed
Jul 1, 2006

The family is the smallest unit of society and it should be a source of happiness for the individual. This is why a sound dialogue between parents and their children is so important. When we bring up our children, we should regard them as being entrusted to us by the Almighty. Treating them affectionately and inspiring confidence in them plays an important role in terms of preparing them for their future life as physically and psychologically healthy individuals.

In spite of the cozy atmosphere of the home, we might come across some problems that are difficult to solve. Some problems are apparent to our friends and neighbors, while others are known only by family members and are kept secret. In such cases, we may not know how to deal with a problem, and therefore need to seek help from an expert. Wetting the bed is a typical example of such problems. When such a problem persistently occurs it is only compounded if we hurt the child and cause them to feel bad or inferior because of this problem; what many people do not realize is that this is a problem that is easily solved.

Families with children who wet the bed while between the ages of 5 and 15, sometimes even up to the age of 20 have a serious problem. Every morning, these families wake up to find another problem. The nasty smell, changing the sheets and cleaning the pajamas are not things that people enjoy first thing in the morning.

Along with the burden of dealing with dirty clothes and sheets, the family members become worried, as they do not know when the problem will end. But it is the child who worries most. The problem is only compounded as the child realizes that they cannot have friends to stay, nor stay at someone else’s house, as this may lead to others finding about the problem; such worries only cause further problems such as losing self-confidence, inferiority complexes, shyness and poor performance at school.

Some families do not try to search for solutions, saying illogical things like, “His uncle used to wet the bed too. That didn’t go on for too long. The same will happen with our child as well,” or “It’s nothing unusual. Most children do it. It will be alright,” or “It will just stop without treatment. They say that there is no treatment anyway.”

Bedwetting is actually a common problem. What then, are the underlying reasons? How common is it in reality? Is there an effective treatment for it? Does it just stop on its own? If so, when and how does it stop? Or is it possible for someone to remain a bed-wetter all of their lives? Does the treatment have any side effects? What is the success rate of the treatment? We will try to answer all these questions.

Occasional cases of bedwetting until the age of five are considered as nothing unusual. If bedwetting continues after the age of five, then this indicates an illness known as “enuresis.” Research carried out on primary school aged children found that between 20-30% of children wet the bed in general. It is usually more common among boys. The percentage increases with children from families of a lower socio-economic background, mostly due to malnutrition.

The main causes for bedwetting

Genetic factors are accepted as playing a role, based on the fact that 70% of the children who wet the bed have close relatives with the same problem, and that there is a high incidence rate among identical twins. It is thought to be caused mostly by a lack of an anti-diuretic hormone that reduces urine production at night. There are other reasons as well.

If a person with diabetes has too great an intake of fluids before bedtime they may wet the bed. Moreover, urinary tract infections, kidney stones, parasites, anemia, a lack of calcium, magnesium, zinc, or vitamins (A, B, D, E), problems with adenoids, and enlarged tonsils may all cause bedwetting.

Anemia and adenoids cause hypoxia (a deficiency of the amount of oxygen available in the blood) and hypercapnia (the presence of an abnormally high level of carbon dioxide in the blood). If these conditions are present, then the patient sleeps too soundly and the control of the central nervous system over the other systems is weakened. As a result, the patient wets the bed as they have lost some control over their muscles.

At least half of people who suffer from bedwetting are considered to do so because of psychological reasons. If a child begins to wet the bed in spite of having had no such problem before, this indicates that the child subconsciously wants to return to their infancy when they were the center of attention. By wetting the bed, the child might be wishing to receive more care from the parents.

Wetting the bed might be a reaction to family problems or the birth of a sibling. Various types of anxiety may cause the child to suffer from depression, which is another reason that causes very sound sleep.

Bedwetting is thought to result from psychological problems if it is accompanied by problems like suffering from a tic, stuttering, nail-biting, over-jealousy, or failure at school. A child with a urinary tract or bladder infection or kidney stones may not be able to control their need to urinate during the day either. If no physical illness can be detected, then there may be a serious psychological disorder.

Diagnosis and treatment

Starting from the principle “every disease has a cause,” we should first of all search for any possible causes. We can begin with simple ways, such as urine and blood tests. If these do not provide a satisfactory answer, then the other possible causes that were mentioned above should be investigated. The kidneys and the bladder should be checked with an ultrasound, while the adenoids and chronic bronchitis, as well as the tonsils, should be examined. If no viral or organic cause can be found, then psychological problems should be investigated. When the reason has been found, then it is time to start the treatment.

After a diagnosis has been made, the parents should be informed about the cause of the problem. It should also be noted that enuresis may result from incorrect forms of toilet training.

In the treatment of psychologically-caused cases of bedwetting, taking the child to a doctor, carrying out blood and urinary tests, and the family’s efforts to treat the child (i.e. paying for the treatment, waiting at the doctor’s, etc) are all considered to be part of the treatment. The child sees that importance has been given to them, that efforts are being made and that money is being spent on them alone. Having seen that the parents and the doctor have played their part, it is the child’s turn to do what is expected of them. Prescribing the correct medicine, or if there is no physical problem, merely saying, “nothing is wrong” is the start of the treatment.

If the bladder turns out to be smaller than normal, the child is advised to hold their urine longer than normal in order to expand the bladder. The period of waiting is lengthened gradually. The child is asked to keep a record of “wet” and “dry” days and they are rewarded for the “dry” days. Drinking less in the evening may facilitate treatment.

Medication and treatment

The medication changes according to the diagnosis. For instance, if there is a urinary tract or bladder infection, then antibiotics are used. If there are psychological reasons, special pediatric anti-depressants will be prescribed. Anti-depressants cause the patient to sleep lighter. When the child does not sleep so soundly, they are able to control their urination, and wake up and go to the toilet.

There are drugs that help to expand the bladder capacity of people whose bladders are smaller than normal; these drugs can be very useful indeed. Some problems with the urinary tract or bladder can also be eliminated by surgery.

If the patient has trouble breathing due to adenoids or enlarged tonsils, these should be removed by surgery as well. For anemia, the patient is given substances such as vitamins, iron and zinc along with a prescribed diet. In cases of calcium deficiency, a calcium-rich diet and calcium tablets are recommended.

If a child shows more than one of the symptoms, then a combined treatment is followed. Laser acupuncture treatment can also be useful. Bedwetting can be prevented by using anti-diuretic hormone tablets or sprays as well. With the correct diagnosis and treatment, the success rate of such treatments is between 95-98%.

The most common occurrence is that children will stop wetting the bed after puberty without any need for treatment. However, it is not a good idea to wait for this to happen, because treatment that will help bedwetting stop occurring is available. Only 2-5% of patients continue to wet the bed after the age of twenty. Most often, such patients wet the bed due to some organic problem.

The medicines prescribed against bedwetting have been in use for about 30-35 years; they have been proven to be safe and to have no side effects.

A related study

In a study carried out in Bursa, Turkey, the records of 164 patients who suffered from bedwetting were examined. According to this study, the following data was obtained: 52 patients (32%) were girls and 112 patients (68%) were boys. 36 of the boys were aged 6-8, 48 of them were aged 9-12 and the remaining 28 were 13 years of age or older. 20 girls were aged 6-8, 16 girls were aged 9-12 and 16 girls were 13 or older.

When the causes were investigated, it turned out that 18 of the 112 boys (16%) had urinary tract or bladder infections and kidney stones, while 18 boys were suffering from cystitis, which can be diagnosed with an ultrasound, 12 boys (11%) had problems with their adenoids, chronic bronchitis, and tonsils, which made breathing difficult for them. No organic causes were found in 64 patients (57%); in these cases it was found that the cause was purely psychological. 24 out of 52 girls (46%) had urinary tract or bladder infections, while the other 54% had psychological reasons for wetting the bed.

Half of the patients stopped wetting the bed at the end of the first month, and almost all the patients were treated successfully by the end of the second month. The success rate was 98%.

After having examined this data, it is clear that the problem of bedwetting is not difficult to solve without blaming and hurting our children. When we confront such problems in life, we should not despair or panic. We should keep in mind that God Almighty has created a cure for every problem, and that finding the cure requires patience and determination.