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Bedwetting
Bedwetting (or sleepwetting) is involuntary urination while asleep after the age at which bladder control would normally be anticipated. Doctors call this condition, "Nocturnal Enuresis."
Parents tend to consider bedwetting a problem earlier than do physicians. Most children (85-90%) will consistently stay dry by age 6. By age 10, 95% of children are dry at night. Studies place adult bedwetting rates at between 0.5% to 2.3%. A small percentage (5% to 10%) of bedwetting cases are caused by specific medical situations. Most cases, however, do not have a specific identifiable cause. [1] Treatment ranges from behavioral-based options to medication.[2] Much of the rationale for treatment revolves around protecting/improving the patient’s self-esteem (Ilyas & Jerkins, 1996). [3]. Additional recommended knowledge
Usual developmental processMost bedwetting can be described as, "a bothersome alteration in normal development." [4] The usual development process is:
Frequency of bedwetting (epidemiology)Males are more likely to wet the bed than females. Males make up 60% of bed-wetters overall and make up more than 90% of those who wet nightly (Schmitt, 1997). Doctors frequently consider bedwetting as a self-limiting problem, since most children will grow out of it. Approximate bedwetting rates are:
Children 5 to 9 years old have a spontaneous cure rate of 14% per year. Adolescents 10 to 18 years old have a spontaneous cure rate of 16% per year. As can be seen from the numbers above, 5% to 10% of bedwetting children will not outgrow the problem, leaving 0.5% to 1% of adults still dealing with bedwetting. [6] Individuals who are still enuretic at age 18 are likely to deal with bedwetting throughout their lives. Adult rates of bedwetting show little change due to spontaneous cure. [7] Studies of bedwetting in adults have found varying rates. The most-quoted study in this area was done in the Netherlands. It found a 0.5% rate for 18-64 year olds. A Hong Kong study, however, found a much higher rate. The Hong Kong researchers found a bedwetting rate of 2.3% in 16 to 40 year olds. [8] Medical definitions (clinical criteria): primary vs. secondary enuresisThe medical name for bedwetting is nocturnal enuresis. The condition is divided into two types: primary nocturnal enuresis (PNE) and secondary nocturnal enuresis. Primary nocturnal enuresis (PNE)Primary nocturnal enuresis occurs when a child is beyond the age at which bladder control would normally be anticipated and:
Some medical definitions list primary nocturnal enuresis (PNE) as a clinical condition at between 4-5 years old. This type of classification is frequently used by insurance companies. It defines PNE as, “persistent bedwetting in the absence of any urologic, medical or neurological anomaly in a child beyond the age when over 75% of children are normally dry.” [9] Other definitions for PNE cast themselves as more “practical” guidance, saying that bedwetting can be considered a "clinical problem" if the child is unable to keep the bed dry by age seven. [10] D'Alessandro refines this to bedwetting more than 2x/month after the age:
Secondary nocturnal enuresisSecondary enuresis occurs after a patient goes through an extended period of dryness at night (approx. 6 months or more) and then reverts to night-time wetting. Secondary enuresis can be caused by emotional stress or a medical condition, such as a bladder infection. [12] U.S. psychological definitionPsychologists may use a definition from the American Psychiatric Association’s DSM-IV, defining nocturnal enuresis as repeated urination into bed or clothes, occurring twice per week for at least 3 consecutive months in a child of at least 5 years of age and not due to either a drug side effect or a medical condition. Even if the case does not meet this criteria, the DSM-IV definition allows psychologists to diagnose nocturnal enuresis if the wetting causes the patient clinically significant distress. [13] When treatment is recommendedDoctors consider medical evaluation/intervention when:
Only a small percentage of bedwetting is caused by the first two items (see below). Most treatment is covered under the third, with physicians being concerned about the child's emotional welfare. Parents become concerned much earlier than doctors. A study in 1980 asked parents and physicians the age that children should stay dry at night. The average responses were:
Normal processes of staying dry (regulation in the organism)Children usually achieve nighttime dryness by developing one or both of two abilities. There appear to be some hereditary factors in how and when these develop.
Causes of and increased risks for bedwettingThe following list summarizes bedwetting's known causes and risk factors. Enuretic patients frequently have more than one cause or risk factors from the items listed below.[15] Most-common causesMost cases of bedwetting are PNE-type, which has two related most-common causes:
There is no test to prove that bedwetting is only a developmental delay and genetic testing offers little or no benefit to a bedwetting patient. Other proven causesDoctors examining a bedwetting patient will search for the following, less frequent, causes of nocturnal enuresis. These causes are more common in secondary nocturnal enuresiscases. Only a small percentage of primary-nocturnal-enuresis type bedwetting is caused by one of the following specifically-identifiable causes. [19]
Unconfirmed or controversial causes
Psychological-social impactA review of medical literature shows doctors consistently stressing that a bedwetting child is not at fault for the situation. Many medical studies state that the psychological impacts of bedwetting are more important than the physical considerations. “It is often the child's and family member's reaction to bedwetting that determines whether it is a problem or not.” [40] Impact on self-esteemBedwetting children feel effects ranging from feeling cold on waking, being teased by siblings, being punished by parents, and being afraid that friends will find out. Whether bedwetting causes low self-esteem remains a subject of debate, but several studies have found that self-esteem improved with management of the condition. [41] [42] Children questioned in one study ranked bedwetting as the third most stressful life event, after parental divorce and parental fighting. Adolescents in the same study ranked bedwetting as tied for second with parental fighting. [43] Psychologists report that the amount of psychological harm depends on whether the bedwetting harms self-esteem or development of social skills. Key factors are:
Behavioral impactStudies show that bedwetting children are more likely to have behavioral problems.
As mentioned previously, current studies show that is is very rare for a child to intentionally wet the bed as a method of acting out. Historical psychological perspective on bedwettingPsychological theory through the 1960s placed much greater focus on the possibility that a bedwetting child might be acting out, purposefully striking back against parents by soiling linens and bedding. (More recent research and medical literature states that this is very rare.) Punishment for bedwetting: rates and effectsMedical literature states and studies show that punishing or shaming a child for bedwetting will frequently make the situation worse. Doctors describe a downward cycle where a child punished for bedwetting feels shame and a loss of self-confidence. This can cause increased bedwetting incidents, leading to more punishment/shaming, “an escalating cycle of wetting accidents and shame.” [50] In the United States, about 25% of enuretic children are punished for wetting the bed. [51] In Hong Kong, 57% of enuretic children are punished for wetting. [52] Parents with only a grade-school level education punish bed-wetting children at twice the rate of high school- and college-educated parents. [53] Impact on familiesParents and family members are frequently stressed by a child’s bedwetting. Soiled linens and clothing cause additional laundry. Wetting episodes can cause lost sleep if the child wakes and/or cries, waking the parents. A European study estimated that a family with a child who wets nightly will pay about $1,000 a year for additional laundry, extra sheets, disposable absorbent garments such as diapers, and mattress replacement. [54] Despite these stressful effects, doctors emphasize that parents should react patiently and supportively. [55] Treatment and management optionsThere are a number of treatment and condition-management options for bedwetting. The following options apply when the bedwetting is not caused by a specifically-identifiable medical condition such as a bladder abnomality or diabeties. It is important to note that punishment is not effective and can interfer with treatment. Treatment options with high success rates
Condition management options
Unproven/ineffective treatment options
See also
ReferencesCategories: Sleep disorders | Urology | Pediatrics | Mental disorders due to a general medical condition |
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This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Bedwetting". A list of authors is available in Wikipedia. |