Bladder control

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Up to the age of five, most children are dry at night. But older children still go to bed (enuresis) or wet their pants during the day (urinary incontinence), parents are often worried. However, doctors emphasize that enuresis and urinary incontinence are common and can be easily treated. 

Parents should know that: 

• About 10 percent of children (boys twice as often as girls) still wet the bed by the age of seven

• About 2-3% of seven-year-old children wet their pants during the day

• Bedwetting can run in families

• Daytime wetting has various causes

• Bedwetting and enuresis during the day become less common as you get older - although one to two percent of young people still wet at night (the figure is 0.5% to 1% during the day).

If children over the age of 5 still urinate, this is only in rare cases an indication of a kidney, bladder or other physical illness. Rather, bladder control, which develops more slowly than in other children, is often the cause of bedwetting, which is predominantly genetic.  There are also psychosocial reasons for bedwetting, which can trigger relapses. If a child begins to wet the bed again after months or even years of staying dry, this may be due to:Fears or insecurities lying that puts strain on the child. These can be caused, for example, by moving to another city, the loss of a family member or the birth of a sibling. But anger with other children, with educators or teachers can also lead to a relapse. Parents can trust that children never intentionally wet the bed; they are usually ashamed of the incident. You should therefore encourage your child and convey to him that you are firmly convinced that he will soon stay dry at night. 

There are many different forms of daytime wetting that have different causes. The rate of accompanying physical illnesses such as urinary tract infections is also higher than with bedwetting, so children must be examined particularly carefully by a pediatrician.

A visit to the pediatrician can often be very helpful in identifying the causes of the enuresis. If necessary, he can refer you to a child and adolescent psychiatrist. If you have mental problems, such as ADHD, persistent sadness, confusion or a change in eating and sleeping habits, parents should contact a child and adolescent psychiatrist with their child. He tries to solve the problems together with the child and his parents.

 

Causes of bedwetting (enuresis)

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Bladder function normally develops during the first four years of life. Infants empty their bladders involuntarily in the first year, but are dry between voids. It is only when children are one to two years old that they become increasingly aware of the need to urinate, so that they are able to let them know when they need to go to the toilet. However, they are often only able to consciously control the sphincter between the ages of two and four. If the children are dry during the day, the nighttime wetting may continue for a while. Many children do not stop wetting at night until they are five years old. Toilet training usually does not affect wetting.

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Many children have inherited the predisposition to bedwetting from their parents: if one parent wets the bed as a child, there is a 40 percent probability that the children will also wet the bed. If both parents were affected, the risk increases to 75 percent.  

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Most commonly, bedwetting is due to delayed maturation of bladder control in the brain. In some of the affected children, the day-night rhythm in the pituitary gland may not yet be fully developed. Therefore, too little of a hormone is produced at night that reabsorbs the fluids from the urine-forming apparatus in the kidney. They therefore produce large amounts of urine even at night. Children often sleep so deeply that they do not feel the urge to urinate and empty their bladder unnoticed in bed.  Finally, bladder emptying is not sufficiently inhibited during sleep. This is also usually due to a developmental delay. 

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In addition, psychosocial factors can trigger bedwetting. The birth of a sibling, the separation of parents or a death in the family can put a lot of strain on a child, causing the previously dry child to wet again.  Other possible risks include existing Attention deficits and hyperactivity in the child, Disturbances in social behavior or intellectual disabilities. Sometimes the affected children also defecate.

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Any wetting is considered enuresis. referred to during sleep. 10% of 7-year-old children and 1-2% of adolescents are affected. When it comes to bedwetting, experts differentiate when classifying the disorder as to whether a disorder of bladder function is responsible for the enuresis or not. In most cases, children wet at night without there being any bladder dysfunction.

Sometimes nocturnal enuresis is accompanied by frequent urge to urinate during the day, delay in going to the toilet, or difficulty emptying the bladder. Experts speak of secondary enuresis when children who were previously dry for at least six months start wetting at night again.