Did your child immediately transition out of diapers to being dry at night?
Did your child take a while but eventually get dry on his own?
Did your child need tips and encouragement to get to dry?
Is your child still struggling with getting dry?
Menachem, a cheerful ten-year-old, really wants to go to sleep-away camp this summer. He is old enough and feels comfortable being away from his parents for a month or two, but he still can’t go away for the summer. Menachem’s parents want him to gain independence and experience new adventures; unfortunately, from the age of eight, Menachem has been wetting his bed at night.
The bedwetting is a mystery to his parents. They cannot understand why it started and do not know how to help him. Menachem goes to sleep hoping that he will not wet his bed that night and wakes with sense of shame when he realizes he has. For the past two years, Menachem’s bedwetting has kept him from sleepover parties and Shabbos away with friends.
Causes of Bedwetting
In rare situations, children are born with enuresis, a congenital condition that reduces bladder control. However, if a child, like Menachem, was holding his bladder at night and later lost control, it is unlikely that enuresis is the cause. How can a child hold his bladder during the day, but fail to do so at night?
Deep Sleep
To answer that question, we need to understand the three skills involved in controlling one’s bladder. In Getting to Dry: How to Help Your Child Overcome Bedwetting, authors Max Maizels, Diane Rosenbaum, and Barbara Keating outline them:
The ability to sense when a bladder contraction is imminent.
The ability to voluntarily inhibit the bladder muscle from contracting.
The ability to contract their urine-holding muscle (the one we rely upon if the line to the bathroom is very long).
The common threads of these functions are sensation and volition – indicating that children who bedwet sleep so deeply that they may not have the skill to perform these functions.
Heredity
A recent study indicated that there is a genetic predisposition to nighttime bedwetting. Statistically, a child’s chance of wetting is forty percent if one parent wet as a child and increases to seventy percent if both parents did. This could be because the child inherited the parents’ ability to sleep deeply, but also signals that bedwetting is not a result of bad parenting or laziness on the child’s part.
Anxiety
Bedwetting as a result of anxiety is a controversial subject; however, there are several experts who claim that extreme anxiety can induce children to wet their beds at night. The Cleveland Clinic indicates that disruptions in nighttime routines that provoke anxiety may also provoke bedwetting.
Myths and Realities
Myth: Bedwetters are immature. We celebrate our children’s toilet training by saying, “Wow, you are a big girl!” Or, “Come look at what a big boy Menachem is!” But, in reality, late toilet training is not tied to developmental delays. Children are not “slow” or immature if they fail to stay dry at night, they might simply sleep too deeply to recognize their need to urinate.
Myth: Bedwetters are too lazy to get out of bed and use the bathroom. Occasionally, older children, like Menachem, are charged with being lazy. Parents or siblings will ask them, “Why don’t you just get up at night when you feel like you need to go?” The reality is that no one enjoys sleeping in a wet, cold bed. Children who wet their beds simply do not feel the urge to urinate while they are sleeping.
Myth: Parents of children with wetting problems have failed to raise their children adequately. As we have noted, there is little that parents can do to prevent bedwetting before it starts. There is, however, a lot that parents can do to help children stop once it has begun.
Treatment
Talk to your child. See if there is something that is bothering him. Maybe you just moved to a new home and he needs some time to adjust. Figure out a way that you can make him more comfortable in his surroundings.
Read books about bedwetting. It is important that your child not feel ashamed. He should understand that it is something you will work with him to overcome. If your child is already reading, the book Dry All Night by Alison Mack might help him identify with other children who struggled with bedwetting and overcame it. If your child is not reading yet, books such as Maribeth Boelt’s Dry Days, Wet Nights or Jane Clarke’s Dippy’s Sleepover might give him hope that he will eventually stop bedwetting.
Contemplate using a “wetness alarm.” A wetness alarm is a sensor awakens the child from his deep sleep if he begins to wet. This method should only be used if your child, like Menachem, expresses an extreme interest to stop wetting his bed. If you force this upon your child without his approval, it will probably fail.
Do exercises. Strengthening several muscles can help your child control his bladder even while sleeping. Kegel exercises, often done in yoga classes, may help your child strengthen important muscles in order to ensure dryness at night.
Perhaps the most important thing to remember is that your child might feel a profound sense of shame regarding his bedwetting. Therefore, it is important to approach the issue with sensitivity and care. Recognizing that bedwetting unconscious and unintentional is the first step towards curing the problem.