Wet Sheets & Silent Struggles: Navigating the Terrain of Nocturnal Enuresis
Written by Keerthi Aithal, Psychologist, Ph.no: +919980476255
Read time 5 minutes
(Credits: https://www.childrensmercy.org/parent-ish/2019/02/bedwetting/)
Bedwetting, also known as Nocturnal Enuresis, is a common problem seen in children characterized by the involuntary voiding of urine during the day and/or at night.
Bedwetting is not a consequence of any underlying medical conditions such as a lack of bladder control due to any neurological disorder, epileptic attacks, or any structural abnormality of the urinary tract (a urinary tract blockage or narrow urethra, a small bladder), hormonal imbalance (under secretion of anti-diuretic hormone (ADH) which slows down how much urine is made during the night), ongoing constipation (the muscle involved in passing urine & stools may not work well), obstructive sleep apnea, transient enuresis as a result of cystitis, or polyuria (as from diabetes), all of which have to be ruled out before diagnosing Bedwetting (Nocturnal Enuresis).
Bedwetting is considered abnormal only if,
- The involuntary voiding of urine occurred at least several times per week (in a child above 5 years of age).
- It continues into adolescence or adulthood.
Genetic Predisposition to Bedwetting:
Bedwetting can also be genetic. This means that if a person's biological parents or siblings had nocturnal enuresis, their children are more likely to have the same condition.
Psycho-Socio-Behavioral Problems of Bedwetting:
Most often, bedwetting is associated with widespread emotional or behavioral problems. Research shows the association between childhood & adolescence bedwetting urinary incontinence with psychosocial problems in adolescence, such as
Feelings of Guilt & Shame:
Bedwetting among children can lead to feelings of guilt & shame. Negative reactions from parents can have a terrible impact on the child's mental health.
Anxiety Issues:
Children who wet their beds might often live with constant fear of their peers & others finding out, being teased & ridiculed by them, which can cause a lot of distress & anxiety around the bedwetting act, leading to anxiety issues in other areas of life such as academic anxiety, anxiety towards peers, teachers & any school-related activities, anxiety towards performing any daily activities, often accompanied by confusion & indecisiveness.
Peer - Victimization:
For children, what their peers say & do means a lot. So, children constantly strive to get a sense of belongingness, acceptance, appreciation from their peers. Hence, children who wet their beds often go through fears of being humiliated, and often they get bullied & victimized by their peers.
Self-Esteem Issues:
Children who wet their beds often suffer from a poor self-image if adequate support wasn't provided during their childhood. How parents perceive and respond to the child's bedwetting becomes important as it shapes the child's perception regarding the act, in turn shaping the perception of self in relation to others.
Sleep Issues:
Frequent bedwetting in children can lead to sleep issues. Children who wet their beds might experience a lot of stress while going to sleep, which might affect the quality of sleep, in turn affecting their mental health.
Social Anxiety Issues:
A child's social life gets negatively impacted by the bedwetting act. They fear being ridiculed & often avoid social events such as school outings, campings, family gatherings, sleepovers. Social anxiety issues in adulthood may lead to absences from work & disruption of social activities.
Depressive Symptoms & Elevated Risk of Later Depression & Suicidal Behaviors:
Effects of frequent bedwetting in childhood are found to have significant associations with psychosocial problems in adolescence. Children who were reprimanded by their parents for bedwetting tend to suffer from depressive symptoms. These depressive symptoms might lead to later depression & suicidal behaviors in some adolescents.
Attention Problems:
Often, children who wet their beds frequently suffer from problems with attention as they tend to be preoccupied with a lot of worry thoughts regarding their bedwetting act.
Lower Educational Attainment:
Children going through emotional or behavioral problems might skip classes or drop out from school or college, which, in turn, would lead to lower educational attainment.
Somatic Complaints:
Children who wet their beds might complain of pain in different areas of their body, usually functional & caused due to the psychological stress experienced due to bedwetting.
Bidirectionality of Psychosocial Problems & Bedwetting (Urinary Incontinence):
It is believed that the association between psychosocial problems & urinary incontinence is bidirectional. That is to say that behavioral problems & difficult temperament in early childhood can lead to an increased risk of later incontinence, or, vice versa, i.e., where psychological distress may also emerge when children become aware that urinary incontinence is unusual for their age, or, being reprimanded & negatively evaluated by their parents & peers.
Strong Association of Bedwetting with Neuropsychiatric Disorders:
The most strongly associated condition with enuresis is attention deficit hyperactivity disorder (ADHD). Other neuropsychiatric conditions include oppositional defiant disorder, conduct disorder, obsessive-compulsive disorder & tics.
Parental Influence on Bedwetting in Children:
Studies report a lower prevalence of bedwetting with improvements in parental income, parental occupation, parental education level & living habits.
Parents' personality (parents dealing with poor self-esteem, embarrassment, shame, guilt, anger issues), & parents dealing with mental health-related problems (anxiety disorders, depression, personality disorders, etc.) can adversely affect the mental health of their children, causing immense psychological stress that might lead to bedwetting in children.
Intervention & Support:
Timely intervention & support from Mental Health Professionals (Psychiatrists/Psychologists/Psychosocial workers) can help prevent the emotional & psychological problems faced by children due to Bedwetting (Nocturnal Enuresis) from perpetuating into adolescence, & to help prevent the possible future mental health problems that can occur due to the long-term psychological effects of bedwetting.
References:
1) The ICD-10 Classification of Mental and Behavioural Disorders. Clinical descriptions and diagnostic guidelines, A.I.T.B.S., Indian Edition 2007.
2) Cleveland clinic. Bed wetting.
3) The Psychological Effects of Bed-wetting, Daytime Urinary and Fecal Incontinence. Physical Therapy Specialists, (2017, August 16). https://www.ptspecialist.com/
4) Mayo Clinic . Bed wetting.
http://www.mayoclinic.org/
5) Effects of urinary incontinence on psychosocial outcomes in adolescence European Child & Adolescent Psychiatry, 26(6), 649–658. Grzeda, M. T., Heron, J., Von Gontard, A., & Joinson, C. (2017). https://doi.org/10.1007/
6) Prevalence and risk factors of nocturnal enuresis among children ages 5–12 years in Xi’an, China: A cross-sectional study. BMC Pediatrics, 20(1), 305.Huang, H.-M., Wei, J., Sharma, S., Bao, Y., Li, F., Song, J.-W., Wu, H.-B., Sun, H.-L., Li, Z.-J., Liu, H.-N., Wu, Q., & Jiang, H.-L. (2020). https://doi.org/10.1186/
7)Psychological Aspects of Enuresis in Childhood. Annals of Urology & Nephrology,1(1).Lefeber, T. P. (2018). Lefeber, T. P. (2018). https://doi.org/10.33552/AUN.
8)The Impact of Bed Wetting on Children | Happy Dry Nights. (2021, December 24). https://www.happydrynights.
9)Impact of Bed Wetting. (2012, February 27).
10) American Academy of Child & Adolescent Psychiatry. Bedwetting. https://www.aacap.org/AACAP/
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