Enuresis (day- or night-time wetting or bed-wetting) is a common occurrence that affects about 1 in 8 children starting primary school. It is more common in boys than in girls and can run in families (i.e., a child with enuresis may have a parent who wet the bed as a child). If your child is out of nappies and is regularly wetting during the day, or if night-time enuresis is affecting your child’s self-esteem, anxiety levels, or ability to do things they want to do (e.g., sleep at a friend’s place or go on school camp), then it is recommended that you seek treatment.
Why do children wet themselves?
Usually, a child learns to control their urination in the following three stages: 1) bowel control is attained during sleep, 2) bladder and bowel control is attained during wakefulness, 3) control of the bladder is attained at night.
Enuresis can indicate a difficulty in meeting these stages. This may be due to biological or developmental causes. For example, a child might develop physically later than other children or have a certain sleep disorder that disrupts their sleep cycles. Other causes could be emotional. For example, enuresis is more likely to occur alongside other psychological stressors like parental divorce, school trauma, or abuse.
Treatment options for enuresis
As enuresis is caused by a number of different factors – biological, and/or emotional – there are both medical and psychological treatments.
It is important to rule out initially whether the enuresis has biological causes. Your family GP will be able to conduct a thorough physical examination of your child, including a urinalysis, and provide the appropriate referrals for specialists if necessary.
The assistance of a psychologist is an integral treatment component for enuresis once medical causes have been ruled out.
Behavioural therapy sessions with a child psychologist can help teach your child to become aware of the body cues which signal toileting. Strategies can then be taught that can help them gain control over their bladder.
If your child is experiencing enuresis due to other psychological stressors, psychological treatment of the underlying stressors can also lead to a reduction in the enuresis.
Specific behavioural strategies for enuresis
- For day-time wetting: stay calm when your child wets. If you notice wet clothing, calmly state “I can see that you’re wet, go and change your clothes”. Avoid punishment, criticism, or shame. Instead encourage your child to get involved in cleaning up and putting clothes in the wash, This acts as a natural consequence.
- For night-time wetting: don’t reward your child for wetting by allowing them to get into your bed after wetting. Calmly take them back to their own bed and say as little as possible when you return them.
- Don’t take your child to the toilet after they’ve gone to bed. Their brain needs to learn to wake up the body itself when the bladder is full.
- Similarly, do not restrict liquids, as your child needs to become used to the sensation of having a full bladder.
- Create a reward system which provides incentives for the child to use the toilet. For example:
- 1 sticker for each weekday dry afternoon
- 1 sticker for each evening from the time the parent gets home until bed; 1 sticker for every dry night
- 2 stickers every time your child goes to the toilet when you ask them.
- When the chart is full of stickers, give a reward that you and your child have agreed on.
- Remind your child that it is up to them to become the ‘boss’ of their bladder. Bladder control happens when they are able to control their bodies with their minds.
- Respect your child’s privacy. Only discuss your child’s wetting with them, specialists, the nanny, and teacher (if relevant).
- Strategies that ‘externalise’ the problem to the child and emphasise that it is not the child’s fault (e.g., “sneaky wee”) can be helpful as well.
What can I do now?
If you would like to find out more about our treatment for enuresis, or to book an appointment with one of our child clinical psychologists who provides treatment for this condition, please email or call the clinic on 02 9438 2511.