Bedwetting

What it is

Enuresis is the repeated passing of urine into the bed or clothes, whether involuntary or, rarely, intentional, in a child who is old enough to be expected to have bladder control, generally from around age five. Most commonly it happens at night during sleep, called nocturnal enuresis or bedwetting, though some children also or instead wet during the day. It is considered a condition when it happens regularly over a period of months in a child past the expected age.

The single most important message for any parent reading this is that bedwetting is almost never the child's fault and almost never deliberate. A child who wets the bed is not being lazy, naughty or defiant; in the great majority of cases the body simply has not yet developed full night-time bladder control. Understanding this is the foundation of everything that helps, and it is the antidote to the shame and punishment that so often make the problem worse.

What it can look like, and the toll it takes

A child wets the bed at night, often deeply asleep and unaware until they wake wet. It may happen every night or only sometimes, and may have been present since infancy or appeared after a period of dryness. The physical event is simple; the emotional toll can be heavy. Children frequently feel ashamed and embarrassed, may avoid sleepovers and school trips, and can suffer in their confidence and self-esteem, especially if they are scolded or teased. Parents, too, can feel frustrated and worried. Much of this distress is avoidable with the right understanding and approach.

How common is it

Bedwetting is very common, particularly in younger children, and becomes steadily less common with age as bladder control matures, with most children growing out of it without any treatment. It is more common in boys, and there is very often a family history, since a parent who wet the bed as a child commonly has a child who does too. Knowing how common it is, and that most children outgrow it, is itself reassuring.

What causes it

In most cases there is no disease or emotional problem behind it; it reflects a developmental delay in the systems that keep a child dry at night, often inherited. Contributing factors include producing more urine at night than the bladder can hold, a bladder that signals fullness less effectively, and being a very deep sleeper who does not wake to the bladder's signals. Less commonly, bedwetting can be linked to constipation (a full bowel pressing on the bladder), urinary infections, or, when it starts again after a long dry period, to stress, change or, occasionally, a medical issue, which is worth checking. Importantly, bedwetting is not caused by bad parenting or, in most cases, by emotional disturbance, though stress can sometimes contribute, especially to a return of wetting after dryness.

How it is treated

Bedwetting is highly treatable, and the first principle is removing blame and punishment, which never help and only add shame. Reassurance, patience and a matter-of-fact approach come first. Practical measures help many families: managing fluids sensibly through the day, ensuring the child uses the toilet before bed, treating any constipation, and protecting the bed while avoiding making a fuss of accidents. For persistent bedwetting, the most effective treatment is a bedwetting alarm, which wakes the child when wetting begins and, over weeks, trains the body to wake to a full bladder; it has the best long-term results. A specialist may prescribe medication in particular situations, such as a school trip or camp, or where other approaches have not worked, though medication manages the problem rather than curing it. Rewarding effort and dry nights, rather than punishing wet ones, supports the child's confidence throughout.

Enuresis in the African context

In many homes bedwetting is met with scolding, shame, or punishment, and it is sometimes wrongly believed to signal laziness, defiance, a curse, or bewitchment. None of this is true, and all of it makes the problem worse by adding fear and shame to a child who already feels embarrassed. Bedwetting alarms, the most effective treatment, can be hard to find or afford in the region, but the most powerful step costs nothing: a calm, blame-free, reassuring approach, since most children outgrow bedwetting, and shame only delays that.

Helping the child

How the adults respond shapes the child's experience more than anything.

• Never punish, scold, or shame a child for wet nights, since it is outside their control and shame makes it worse.
• Reassure the child that it is common, not their fault, and that most children grow out of it.
• Reward effort and dry nights rather than reacting to wet ones, and protect the bed without making a fuss.
• Keep it private, and protect the child from teasing by siblings or others.
• Treat any constipation, and seek advice if it persists or starts again after dryness. Our find a therapist page can help.