What is bedwetting or Enuresis in children?

This strange word, like many others, comes from Greek and means “to pee on”.The Greeks had a name for everything, which is how it has come to this day. Enuresis refers to when a person pees on himself when it is no longer the age for this to happen. When, evolutionarily, a child should have already learned to control the pee and to do it in a suitable place for it.

Pee and poop control is the most important thing a young child learns, giving greater autonomy and control over the body and the adults.

It has seen fathers and mothers trying to make the child control the pee for a year or a half. Yes, the beginning of this apprenticeship is usually about two and a half years old; it is for a reason. Therefore, the child’s body has to be prepared to retain a large amount of pee until it is appropriate to evacuate it, just as we do now. All elements that make up the genito-urinary tract must have matured, and this does not happen, in general, until that age. Therefore, it is not considered a problem, according to the diagnostic manuals that psychologists use until after five years of age. At that age, the little one must have learned:

It has to identify the physical signs that must go to the bathroom. It is clear when they begin to do it; they touch their genital area, some give little jumps when peeing as if walking through hot coals, and others explicitly say, “I pee”. It means that the little one can perceive the physical sensations that indicate that his body has stored much urine and that it is time to expel it.

Learn to distinguish the physical sensations:

Relate physical sensations to external cues. For example, see a bathroom and know that to pee and use the bathroom even if the desire to pee is low, planning that will not be able to have a bathroom available in the following successive hours.

Moreover, he has to transfer it to the night at the end of everything he has learned during the day.

Uncontrolled peeing is not considered a psychological problem until approximately five years of age due to the different rhythms in the maturation of the child’s urinary system and nervous systems.

If we have a child of 5 years and older who keeps peeing and does not know how to handle it, it is best to consult a psychology professional. And then, the psychologist will ask many questions to know what type of Enuresis little one has. Psychologists differentiate between primary and secondary Enuresis, which sounds familiar. We call it primary Enuresis when, for example, some parents are concerned because their 8-year-old son keeps peeing on himself and has never really controlled it; he has never been able to hold it in consistently over time. It would be secondary when the same child, after having retained for six months (minimum) or more, pees again on himself.

Always for these matters, the first is to go to the paediatrician so that he can examine them. For example, several physical causes can cause a child not to control his or her pee when they are old enough. Therefore, ruling out any physical problems is essential. For example, a prudent psychologist will first ask to take the child to the paediatrician before definitively addressing the problem as a purely psychological matter.

The psychological (and therefore modifiable) causes:

If a child has never held his pee well, that is, he has primary Enuresis symptoms, there may be several causes. First, it is possible that he has not had good learning and that the sphincter has to be strengthened to increase the bladder’s functional capacity. It is also possible that much attention will be given to the child when he is peeing. The subject is talked about for hours, or the family is very aware of it when this happens. Or all at once. We must remember that parents’ attention is the most important thing for a child at this age. If he gets it by peeing, she will repeat it (without him realising it most of the time) to get that attention. 

If a child has already withheld for at least six months and suddenly pees, it may be because something is exciting him emotionally. For example, the arrival of a new sibling, a change of school or home, and painful or traumatic experiences can cause a child to return to behaviours typical of a younger child. If he is sad or angry, explore the child’s environment very well to know what may be happening so that he pees again to know if something in his environment is worrying or scaring him.

A large percentage of children who wet themselves do not do so consciously. In addition, the more Nervous the child is, the more urine is produced and the more likely it is to have more leaks since enuretic children need to go to the bathroom more often. Just look at the adults. When we are under stress or pressure, many of us use more and create more urine. So neither punishments nor scoldings will solve the problem.

Use of diapers:

They are usually very comfortable for the parents and the child. However, they have the problem that the skin becomes desensitised to humidity, and we want them to be able to go to the bathroom when they notice the first drops or the physical signs that alert them that the bladder must be discharged.

Avoid drinking at night. It is not a good solution since our goal is that he can go to the bathroom when he perceives the body’s signals and that he has the muscles of the urinary system well-trained to do so. If we do not let him drink, he cannot learn or practice these things since he barely produces urine. Pay too much attention to him on the days he pees.

The first thing is to rule out possible physical causes of Enuresis. When these have been ruled out, we know the cause is psychological. Below is a list of some treatments or strategies used in the psychological field.

  1. Increase bladder capacity

With the exercise of “holding and retaining” the urine in increasing amounts

2. Strengthen the sphincter

It cuts off the flow of urine when peeing. In the beginning, in the middle and at the end of urination and then release, this makes this muscle stronger.

3. Social reinforcement

For every day that he could hold his pee, both day and night, we had to show him how happy we were that he could do it.

4. Parental care

Parents must give him attention when he can hold his pee, reinforcing his achievements. As long as he pees on himself, he must (according to his age) take care of all the inconveniences of having to pee, pick up sheets, wash his underwear, and shower.

5. Anti-enuretic devices

They are devices that have a humidity sensor and an alarm bell. The alarm sounds at the first drop and immediately wakes the child, who closes the sphincter. This device and similar ones are not very much liked since they only get the first two points on this list. Something that we can do in a less traumatic way for the little one than to set the alarm (quite annoying, by the way) that wakes him up at dawn


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