In medical practice, problems related to bladder control are encountered less frequently. This probably stems from the fact that involuntary urination is much less of a problem than faecal soiling. Bedwetting is most common at the preschool age. In this text, we would like to draw attention to several facts that may be useful to parents and caregivers.
Bedwetting can last until school age, which is also the latest time for bladder control to be normally established. In the case of secondary nocturnal enuresis – that is, when bedwetting reoccurs once bladder control has already been achieved – caution is advised, and it is justified to explore possible organic causes (neurological diseases, disorders of the endocrine or urinary system) or psychological difficulties. In cases like this, one should seek the help of a paediatrician.
Signs of possible organic (physical) causes
- Excessive urination during the night – if the urine volume exceeds the amount calculated by the formula: “age + 1 × 30 ml”. Urine that “slips” into the diaper or bed linen should be measured.
- The child urinates more than six times during the day without consuming excessive amounts of liquid.
- Involuntary urination during the day.
- Sudden and strong urges to urinate that are difficult to control.
- The urine stream is not continuous – it often comes out in an interrupted flow.
- Presence of constipation (obstipation).
Regardless of whether the child suffers from primary enuresis (never achieved control of urination) or secondary enuresis (previously achieved control but relapsed), you should consult your paediatrician if any of the above symptoms are present.
Supporting your child
In the case of primary nocturnal enuresis, it is important to be patient and avoid expressing parental frustration over the problem. The child does not need to achieve full bladder control before school age. Children who wet the bed are often very sensitive and emotionally demanding. Expressions of frustration create guilt, which typically worsens the situation.
A calm and gentle approach is recommended. At the same time, it is important to show a certain degree of firmness, faith that the child will learn to control urination, and determination that the child should assume some responsibility for the consequences. The child can, for example, help to change bed linen and pyjamas.
The use of night diapers is not recommended because they reduce the sensation of discomfort caused by wet clothes. The absence of discomfort prevents the establishment of the control reflex and prolongs the problem.
It is helpful to “train” the bladder during the day by holding in urine for as long as possible. This increases bladder capacity and raises the threshold for triggering urination. Make sure the child urinates before going to bed. Preventive waking during the night is generally not recommended, especially if the child resists being woken up.
Limiting fluid intake during the late afternoon is useful. Children who constantly drink sweet beverages (tea, juice) from a bottle usually consume much more liquid than they need — drinking because it provides a pleasant sensation (the teat and the sweet taste). After the age of three, emotional needs should gradually be satisfied in other ways — through words, play, and parental warmth rather than bottles or sweet drinks.
Additional contributing factors
Children with enlarged tonsils, who mostly breathe through their mouths, may consume more liquids due to dryness in the oral cavity. Sometimes, nocturnal enuresis can occur temporarily when children are suffering from a cold because their nose is congested and they drink more fluids.
Persistent bedwetting that continues into school age requires specialised medical evaluation.
Final note
Bedwetting is usually a transient developmental stage, not a disease. It requires patience, understanding, and gentle support from parents. With proper guidance, most children gain bladder control naturally.
If bedwetting persists or affects your child’s confidence, consult your paediatrician for advice and support.
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