Bedwetting (urinating): causes, symptoms and treatment

Enuresis is one of the elimination disorders, Corresponding to the group of psychopathologies related to the stage of childhood and development. Its manifestation is often the external sign of a kind of internal and intense emotional distress of the little one.

Again bedwetting is a very common occurrence in childhood, this disorder is relatively poorly understood. Far from maintaining the unfounded belief of the commission of such behaviors as willful and malicious acts by the child, we explain below the main characteristics that define this disorder.

What is enuresis?

Enuresis can be defined as the clinically significant difficulty in properly exercising control of the sphincter in the absence of a cause, either organic or derived from the consumption of certain clearly observable substances.

Among the diagnostic criteria, it is noted that the child must perform this elimination behavior in inappropriate situations involuntarily with a frequency equal to or greater than
twice a week for at least three months consecutive.

In addition, this type of behavior must generate significant emotional distress in different areas of the child’s life and cannot be diagnosed until the age of five.

    Comorbidity and prevalence

    The presence of sleepwalking, night terrors and, most importantly, sleep problems are usually associated with the diagnosis of bedwetting. deterioration in self-esteem, incomprehension and parental criticism. Due to these circumstances, the isolation of the little one is derived in terms of participation in activities that involve outings such as excursions or camps.

    The prevalence in each sex varies by age, being higher in younger boys and older girls, although the general proportion fluctuates
    about 10% of the child population. Bedwetting is the most common. In most cases, there is spontaneous remission, mainly of the secondary type, but it can also persist until adolescence.

      Types of bedwetting

      Enuresis can be classified according to three different criteria:
      when the episodes of sphincter uncontrollability, If it preceded a time when the child was able to control urination and if it is accompanied by other concomitant symptoms.

      Based on these criteria, we can establish the following types of enuresis.

      1. Diurnal, nocturnal or mixed enuresis

      Daytime enuresis occurs during the day and is linked to symptoms of anxiety, which are more common in girls. The nocturnal type is more common and is linked to images referring to the act of urinating during REM sleep. Mixed enuresis cases are those in which episodes occur both during the day and at night.

      2. Primary or secondary enuresis

      The qualifier “primary” applies if the child has never experienced a stage of sphincter control. In the case of enuresis
      secondary a control step was observed in the past for at least six months.

      3. Monosymptomatic or polysymptomatic enuresis

      As the name suggests, monosymptomatic enuresis is not accompanied by any other class of symptoms, while polysymptomatic enuresis is accompanied by
      other urinary manifestations such as pollaciuria (Increase in the number of daily urinations).

      the causes

      Without being able to have a general consensus today on the factors that cause enuresis, there seems to be an agreement to establish an interaction between
      biological and psychological causes.

      There are three types of explanations that shed light on the origin of this disorder.

      1. Genetic theories

      Genetic research has found that 77% of children diagnosed with enuresis belong to families in which
      both parents presented this alteration during their childhood, compared to 15% of children from families with no previous history.

      In addition, a greater correspondence was found between monozygotic twins than between dicygotic twins, indicating a significant degree of genetic determination and heritability.

        2. Physiological theories

        Physiological theories defend the
        existence of impaired bladder function, As well as insufficient bladder capacity. On the other hand, a deficient action in the secretion of the vasopressin or antidiuretic hormone has been observed, mainly during the night.

        3. Psychological theories

        These theories advocate the presence of emotional or anxious conflicts that lead to loss of sphincter control, although some authors indicate that it is bedwetting itself that motivates these emotional alterations.

        It seems that the experience of
        stressful experiences like the birth of a brother, Separation of parents, death of a significant person, change of school, etc. they can be associated with the development of the disorder.

        The behaviorist current proposes a process
        inadequate learning of hygiene habits as a possible explanation for enuresis, further indicating that certain parenting patterns may negatively enhance the acquisition of sphincter control.

          Intervention and treatment

          Several are the
          treatments that have proven their effectiveness in the intervention on enuresis, while it is true that multimodal therapies which combine several of the components presented below have a more acceptable success rate.

          Below, we will describe the most common intervention techniques and procedures currently used in the treatment of bedwetting.

          1. Motivational therapy

          In bedwetting, motivational therapy focuses on
          decreased anxiety and emotional disturbances comorbidities with the disorder, as well as in work on building self-esteem and improving family relationships.

          2. The Pee-Stop technique

          The “Pee-Stop”
          it is based on the operating technique of Token Economy. Once the anamnesis has been carried out and the functional analysis of the case carried out through interviews with the parents and the child, a self-assessment on the evolution of the enuretic episodes during each night is prescribed. At the end of the week, there is a point count, and if you have achieved a certain goal, the child receives a reward for success.

          At the same time, follow-up interviews are conducted with the family, peer counseling is provided to increase the effectiveness of bladder function, and progressively more advanced goals are offered.

          3. Dry bed training

          This intervention program proposes a series of tasks divided into three different phases in which the principles of operative conditioning are applied fundamentally: positive reinforcement, positive punishment and overcorrection Driving.

          At first, with the installation of a Pee-Stop device (sound alarm), the child is instructed in the so-called “positive practice”, in which the subject
          you will have to get out of bed to go to the bathroom repeatedly ingest a limited amount of fluid and return to bed and begin to sleep. After an hour, he wakes up to see if he can handle the urge to urinate any longer. This procedure is repeated every hour that same night.

          In case of wetness of the bed, cleaning training is applied, for which the child will have to change both his own clothes and those of the bed that has been soiled before going to bed. back to sleep.

          In a second phase, the child is awakened every three hours until he succeeds
          add seven consecutive nights without wetting the bed. At this point you move on to a final phase in which the alarm device is removed and you are allowed to sleep through the night without waking up. This last phase ends when the child has achieved a total of seven consecutive nights without wetting the bed.

          For every successful night, it is positively reinforced to the child and for each night of uncontrolled positive practice should be applied immediately.

          4. Bladder distension exercises

          They consist in training the child to
          increasendo urinary retention time gradually. The child should warn parents when he wants to urinate and more should be measured and recorded periodically the volume of fluid retained in the bladder each time before urination.

          5. Pharmacological treatments

          Pharmacological treatments, such as desmopressin (an antidiuretic) or oxybutin and imipramine (muscle relaxants to increase the capacity of the bladder), are moderately effective in the treatment of bedwetting because
          they get lost improvements in treatment are abandoned and have significant side effects (anxiety, sleep disturbances, constipation, dizziness, etc.).

          6. Multimodal treatments

          These intervention packages
          they combine different techniques described in the previous lines and are more effective because they attack the alterations produced in the cognitive (psychoeducation of the disorder), affective (coping with anxiety, fears and worries generated), somatic (pharmacological prescription), interpersonal (doing facing family stressors) and behavioral intervention of bedwetting behavior directly).

          Stop wetting the bed

          As you have seen, bedwetting is a complex psychopathology that requires a set of interventions involving the entire family system.

          It is very relevant on
          application of behavior modification techniquesSpecifically, “Pee-Stop” and cleansing training, although just as essential becomes to delve deeper and determine what emotional factors are causing such symptoms.

          Bibliographical references:

          • Belloch, A., Sandín, B. and Ramos, F. (1995). Manual of Psychopathology (Vol. 2, Part VI. Developmental Psychopathology). Madrid: McGraw-Hill.
          • Cavall, V. and Simón, MA (eds) (2002). Manual of clinical psychology of childhood and adolescence, 2 volumes. Madrid: Pyramid.
          • Ollendick, TH and Hersen, M. (1993). Childhood psychopathology. Barcelona: Martínez Roca.
          • Méndez, FJ and Macià, D. (1990). Behavior modification in children and adolescents. Case book. Madrid: Pyramid.

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