Bedwetting (Enuresis)

The term enuresis comes from the Greek word “enourein,” which means “to urinate.” Today, enuresis is used to describe the involuntary and inappropriate urination at an age when developmental control of urination is expected.

Studies on urination indicate that Turkish families do not express much concern about enuresis. In addition to preferring observation or traditional methods to solve this problem, there is a common fear that the medications used in the treatment of children may cause infertility in the future. Therefore, the prevalence of enuresis is higher than what is observed clinically.

During normal development, children typically begin to gain bladder control around the ages of 2-3. Nighttime control is usually completed between the third and fourth years. If bedwetting occurs after the age of five at night or if there is daytime urinary incontinence during sleep, it is referred to as nocturnal and diurnal enuresis, respectively.

For the diagnosis of bedwetting, the child must repeatedly wet the bed or clothes, with a frequency of at least twice a week for a minimum of three consecutive months. It should cause clinically significant distress, impair social, occupational, or other areas of functionality, and the child must be at least 5 years old (or at an equivalent developmental level). Moreover, this behavior should not be directly attributed to the physiological effects of a substance or a general medical condition.

Bedwetting is reported more in males. 60% of those with daytime and/or nighttime bedwetting are male, and 90% of those with only nighttime bedwetting are male. One in every 10-15 boys aged 6-7 wets the bed frequently, compared to one in every 15-20 girls. Nighttime bedwetting is more common in boys, while daytime and nighttime bedwetting is more common in girls. As a result, it is observed in boys at 2-3 times the frequency of girls.

Various assumptions have been put forward for the causes of bedwetting, but none fully explains all cases.

Biological causes in Bedwetting: Familial predisposition: Research suggests that if both parents have a history of enuresis, there is a 70-75% chance of occurrence in children. If only one parent has a history of enuresis, the likelihood of enuresis in children is reported to be 40-50%. Delay in the development of the central nervous system Issues related to bladder physiology Sleep-related causes in Bedwetting Hormonal factors Psychosocial factors Toilet training Challenging life events

Bedwetting Treatment Such problems affect both the child and the family. Wetting the bed frequently can cause the child to feel sad and experience a sense of failure. Additionally, the child may experience insecurity in other areas of life.

Studies show that 23-36% of parents choose punishment as the first treatment option for coping with bedwetting.

Punishment has no role in treatment. One of the most important aspects of treatment is positive motivation. Motivation should be provided for the child to actively participate in the treatment. The timing and type of treatment are individual. The younger the child, the less motivation there will be. Therefore, it is crucial to provide appropriate explanations to the child and motivate them.

Medical treatment in Bedwetting: Imipramine is commonly used in the medical treatment of enuresis, along with desmopressin.

Behavioral treatments Record keeping and rewarding: Keeping a calendar and rewarding techniques are both motivating and responsibility-imposing methods in the treatment of enuresis. The child marks wet or dry nights on a calendar. These marks should definitely be made by the child themselves. If dry days are frequent during weekly check-ups, rewards are given (playing a game the child likes, etc.). Emotional rewards (praise, hugging, patting on the head, exaggerating their success, etc.) are more effective than concrete rewards (toys, food, etc.).

Fluid restriction and waking up at night: Restricting fluid intake before bedtime (tea, cola, watermelon, etc.) can reduce the amount of urine during sleep. Responsibility for fluid restriction should be given to the child. If children are awakened 1-1.5 hours after falling asleep to go to the bathroom, the success of fluid restriction increases. However, parents should not carry the child to the bathroom, but rather encourage the child to go to the bathroom themselves.

Bladder exercises: Suddenly stopping and resuming urination several times while urinating during the day can increase the tone of the sphincter muscles and make the child aware of bladder control. This method is understood to be more applicable to children over the age of 9.

Alarm device: An electronic bell device attached to the child’s underwear or bedspread is used.

The course of enuresis is generally positive. Although the problem decreases with age, it can persist during adolescence.

Children and families experiencing this problem can go through challenging periods. Therefore, physiological problems must be investigated, and it is recommended to consult a child mental health specialist.”