By Jessie-Anne Bird – Educational Psychologist
Enuresis – or involuntary urination – is a challenge that faces many parents, and occurs more commonly than many of us realise. Enuresis can occur during both day and night, is diagnosed in children over the developmental age of five years, and can either be primary (when a child has not been able to gain bladder control) or secondary (when a child has previously gained bladder control for a period of 6 months of longer). Bedwetting is one of the more commonly known forms of enuresis. A medical consultation with the child’s doctor should form the first step when there are concerns about involuntary urination as there can be multiple causes which are often physiological. A medical doctor will also be able to advise on treatment and intervention.
Many parents have asked whether stress can cause bedwetting. The link between bedwetting and stress can be a complicated one, and is usually multi-directional. While stress does not directly cause bedwetting, enuresis can cause severe emotional and psychological stress for both parents and children. Toileting problems can have an impact on children’s social and educational development that can go beyond what happens inside (or outside) the bathroom. Children may be excluded, ostracised, shamed by their peers, teachers, or parents, and this can lead to low self-esteem. If unaddressed, this can go on to cause emotional and behavioural challenges. This is especially true for school aged children, who are often aware of the age-related pressure to control their bladders.
Stress can also worsen existing difficulties with bedwetting, as it impacts sleep, day-time behaviour, and diet. The birth of a sibling, moving house, divorce, school challenges, and many other changes can even disrupt toileting habits which have already been formed.
When a child experiences enuresis, there are several things we should keep in mind when deciding how we want to help them. Age, and level of development are the first factors to investigate. We should also consider whether a child is worried or concerned about the bedwetting, and what it means for them. It is important that a child’s wishes be taken into consideration when making decisions regarding their health and well-being. A child’s level of motivation, self-efficacy beliefs, and emotional responses to bedwetting should be explored in a safe, comforting manner, as these can have a important impact on the success of any intervention.
Parents can help their children navigate the way through enuresis by communicating unconditional acceptance and love for their child (whether they remain dry through the night or not!). It is also crucial that accidents be viewed as unintentional and uncontrollable, and not something to be punished or shamed. A child’s attempts to develop control should be emphasised and rewarded – even if not always successful – the development of bladder control often takes time, and may have a few obstacles along the way.
Bedwetting can often be associated with strong parental reactions – the frustration of cleaning up the mess, the worry about the child’s development, and perhaps even anger towards the child. The way a parent responds can play a large role in making a change – whether positive or negative. Appropriate positive reinforcement for behaviours that increase the liklihood of remaining dry should be increased, while negative reinforcement should be avoided. This should, in turn, help reduce the stressful interactions that may follow on from an incident of bedwetting. Finding reasons to offer praise and encouragement can create the opportunity for positive and meaningful interactions for all family members.
Supporting a child who is experiencing bedwetting often involves encouraging them to take control of their own bodily functions. Developing bodily awareness, responding to physical cues, and learning how to understand their own needs can form the beginning of increasing their sense of autonomy. Enuresis often represents a loss of control, and can leave a child feeling helpless. By providing children with tools to reduce the mess associated with bedwetting, and the power to manage their own bodies independently, can help overcome the sense of powerlessness that may be associated with enuresis. Cutting down the mess of bedwetting reduces the stress, and prevents unnecessary embarrassment. The use of measures such as diapers can greatly improve a child’s feeling of security before going to sleep, and can give them a sense of freedom from the worry of bedwetting. This, however, might not work for all children. Teaching children developmentally appropriate chores associated with their accidents can give them an added ability to recover from accidents, without feeling helpless. These responsibilities should not be presented as a punishment, but should encourage feelings of independence.
Sometimes shifting the way we treat our children can be challenging, and can seem daunting without support. Changing the way one parents often requires moving away from the way one was parented as a child, and this can be especially difficult. Additionally, parents may find themselves disagreeing on the best way forward when trying to prevent bedwetting from happening. Assistance for parents, children, and families can relieve some of the pressure, and can help with decision making about the best course of action to take. The Johannesburg Parent & Child Counselling Centre can provide a space for parents to discuss how to support a child emotionally and psychologically through this process.
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