Keeping eyes dry over wet nights
Although a relatively common problem, the reasons for bedwetting remain a mystery
There are few conditions more synonymous with the traumas of growing up than bedwetting. The majority of children are dry by the age of five but, for a minority, bedwetting persists sometimes into the teenage years.
This can cause embarrassment and distress for children, but also for their parents too and, in worst case scenarios, it can lead to a vicious cycle of recrimination which exacerbates the problem.
Bedwetting can blight many a childhood as the child is circumscribed in their ability to do the things that so many of their contemporaries do, such as sleepovers and nights away with sports clubs or the scouts.
Why does it happen?
Bedwetting occurs when children produce a low level of the hormone Vasopressin. As a result the signal that comes from having a full bladder is not processed and the children wet themselves.
There are three types of bedwetting. Some 75 per cent of children have night time wetting. Half of them produce too much urine, the other half produce a normal amount of urine, but the connection between the brain and the bladder does not function properly. Though it has been established how children wet the bed, the reasons why some children are bedwetters and others aren’t remains a mystery.
“If we knew the reasons why we might have a better explanation and maybe a better way for treating people as well,” says Dr Nick van der Spek, a Dutch-born paediatric consultant at Cavan General Hospital. “We don’t really know. We know there is a genetic component of it.”
He says parents who worry about their children wetting the bed can be assured the problem is much more common than they might expect. Some 15 per cent of children aged five still wet the bed as does one child in 20 aged 10 years. The problem can persist even into teenage years in a very small number of cases.
Though bedwetting can lead both parents and children to despair, there are numerous treatments that can be used and the success rate is close to 80 per cent.
The powers of star charts and rewards for dryness cannot be underestimated. The sub-conscious is a powerful weapon in combating what is called enuresis in the medical profession. Regulating the child’s drinking, limiting potential diuretic drinks and a bed alarm to wake the child when he or she wets are other solutions that can work, but punishment never has a place in the treatment of bedwetting. “A lot of behavioural treatments are effective in reducing that. That would suggest there is a learning component to it,” van der Spek says.
Van Der Spek says there is a myth out there that bedwetting is the result of childhood trauma. He says very occasionally dry children become bedwetters as a result of severe trauma, but “the percentage of those is very small”. However, he says bedwetting can be a self-perpetuating thing if parents react wrongly to it and start punishing the children. “It becomes a vicious circle. The vast majority of children who come to us do not have an emotional problem unless the problem is caused by the wetting itself,” he says.
Instead, van Der Spek believes there is a strong genetic element to it. Families with a history of bedwetting are more likely to produce children who also wet the bed, but the reasons why are not known yet.
Researchers in Sweden have identified two potential chromosomes which may be a factor, but more work has to be done.
The same belief is held by Irish GPs, 70 of whom took part in the Enuresis (bedwetting) Omnibus Survey earlier this year.
Nearly half of all GPs have five-eight children with bedwetting under their care and 29 per cent have about double that number. Of those doctors, 47 per cent of them surveyed strongly believe that bedwetting is linked to a family history of the condition. Their evidence suggests there is a trend supporting clinical studies that show it is unusual for a child with bedwetting not to have a parent or close relative who was also enuretic.
Irish GPs report parents delaying their visit to the GP for a year or more. Some 36 per cent of parents report an average of a year-long delay. Dr Pathy Dass, a paediatric surgeon at Tallaght hospital in Dublin, says delaying only compounds the distress for a child “so it is very important that parents face the issue head on and talk to their GP early to find the most appropriate solution for their child”.