Children develop at different rates. This involves not only walking and talking but also becoming dry. Bladder control is a maturational and learning process that needs time and lasts up to about the age of 5 years.
Day- and night-time wetting in children - symptoms
This maturational process is not complete by that age in every child, however. Various factors can contribute to a delay in a child’s becoming dry.
A distinction is made between children who have symptoms at night (bedwetting or, in medical terms, nocturnal enuresis) and those who wet themselves during the day. Combined forms often occur.
Roughly 15% of all 5-year-old children suffer from nocturnal enuresis, boys about two and a half times more often than girls. Daytime urinary incontinence occurs in 5% of children in this age group. Spontaneous resolution occurs in about 15% of affected children per year.
Wetting must be investigated
- In children over 3 years who wet themselves both at night and during the day.
- In children over the age of 5 years who still wet themselves at least twice a month.
- If pain is present with urination, regardless of age.
What is meant by nocturnal enuresis?
Nocturnal enuresis is defined as wetting at night only, during sleep, at least two nights a month in children at least 5 years old.
In primary nocturnal enuresis the child has never been dry, while secondary nocturnal enuresis describes renewed bedwetting after a dry period of at least 6 months.
The causes of nocturnal enuresis are most likely to be developmental delays in bladder control and regulation of urine production.
It is possible that:
- Bladder capacity is too small and urine storage is insufficient.
- Production of antidiuretic hormone (ADH) in the pituitary gland is insufficient. The result is that urine production is not reduced at night-time.
- The child is not awoken by the stimulus of a full bladder, likewise a result of delayed maturation of nerve pathways.
These disorders can be hereditary but may also be influenced by social circumstances such as acts of defiance towards parents, starting school, birth of siblings or parents divorcing.
Incorrect drinking habits should not be underestimated. If children drink too little during the day, the important stimulus to increase the bladder’s storage capacity appropriately is absent and the bladder remains too small. On the other hand children who drink large volumes in the early evening produce too much urine at night, which must be passed.
Bedwetting is very often accompanied by daytime symptoms that become apparent only when looked for. For instance, many children go to the toilet very often during the day, which can be caused by small bladder capacity and episodes of urinary urgency. These children often perform obvious so-called holding manoeuvres such as crossing their legs.
What is meant by urinary incontinence during the day?
If a child wets during the day, different causes may be present. The most frequent form is overactive bladder. This is characterised by frequent urination (micturition) with passage of only small amounts of urine, associated with a strong urge that cannot be suppressed. Signs may include holding manoeuvres (such as leg crossing), intended to postpone urination.
It can be the case that girls cannot relax their pelvic floor during urination, so as a result the bladder does not empty completely.
The causes are different from those of nocturnal enuresis.
- In childhood overactive bladder, bladder control is not yet mature. Voiding occurs despite a small filling volume of the bladder.
- Bladder voiding disorders can be the cause of wetting. Either there is a narrowing of the urethra or urethral orifice or there is incorrect behaviour during urination.
- Congenital neurological diseases or anatomical malformations can also be the cause of urinary incontinence.