The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) indicates precise criteria for the diagnosis of enuresis:
- the repeated emission of urine in bed and clothes;
- a frequency of twice a week for at least 3 consecutive months;
- occurs in children at least 5 years of age;
- behavior not solely due to the direct physiological effect of a substance or general medical condition.
Enuresis
As already mentioned, enuresis is a problem that is mainly found in pediatric age and concerns the involuntary loss of urine. There are two subtypes of enuresis: nocturnal and daytime.
Nocturnal and daytime enuresis
Nocturnal enuresis is characterized by leakage involuntary and intermittent of urine during sleep, in children over 5 years of age and in the absence of another physical disorder that justifies involuntary urination. It has a genetic basis (familiarity has been found in almost 80% of cases) and is more frequent in males. The disorder can be associated with:
- constipation and encopresis;
- cognitive problems;
- attention disorders;
- psychological and behavioral disorders.
Daytime enuresis, or loss of urine that occurs more during the day, is more common in girls than in boys and is rare after the age of nine.
Primary and secondary enuresis
If the child is incontinent for at least six months it is called primary enuresis. However, we speak of secondary enuresis when the child has shown periods of continence of at least six months, and then shows a relapse.
Among the causes of secondary enuresis there can be both physiological-medical and psychological factors. Many researches underline how children who suffer from secondary enuresis may have more psychological problems due to it stressful eventssuch as the birth of a sibling or involvement in road accidents.
When can we say goodbye to diapers?
Often the origin of enuresis can also be linked to early sphincter education. The psychological problems that accompany this disorder can be significant, especially if managed with reproaches or humiliation by adults.
A child who is asked for sphincter control too early in relation to his abilities may end up using enuresis as a form of communication of discomfort towards his parents in a later developmental period.
Urination control education requires a lot of attention and care. It is important that the child is ready from a cognitive and, in particular, linguistic point of view, because he or she must be able to:
- to retain urine;
- to communicate the need to the parent.
Some advice
To facilitate a peaceful transition to sphincter control, it is useful to create the best conditions at home so that the child can accept this change with peace of mind. The little one:
- go involved in the process, allowing him to choose whether to use the toilet seat or potty seat, and to select the color or decorations he prefers;
- should experience the situation as ashared activity: even the choice of panties can become a moment of participation;
- must be accompanied to the bathroom with regularity at first, allowing him to stay away a little longer than necessary.
Furthermore, it is important to remember that:
- this process should not be started during other periods of stressful change for the child, such as a change of residence, the arrival of a little sister or brother, or abandoning the pacifier;
- the child must not be discouraged (and the same goes for the parent) in case of accidents;
- every success should be valued as an opportunity to compliment the child;
- all the people who take care of the child (grandparents, nannies, parents and teachers) should collaborate consistently and in the same way.
Treatment
To treat enuresis, cognitive behavioral therapy actively involves both parents and the child. It is important that everyone takes on a specific role to help resolve the problem: this can determine the success of the treatment.
Observation
Observation represents a fundamental phase of the intervention: parents are provided with forms which, for at least 2 weeks, must be filled in to:
- write down the enuretic incidents children’s nocturnes;
- identify the critical time slot where urine leaks occur (as they often become unconscious habits).
All this without ever waking the baby.
Psychoeducation
The psychoeducational phase allows parents and the child to:
- learn more about the disorder;
- understand what has maintained the problem over time;
- understand what needs to be changed, both during the day (for example hygiene practices when going to the bathroom) and during the night (such as eliminating diapers or waking up to go to the bathroom).
It is important not to be in too much of a hurry to change: adult expectations can often create strong pressure on the child, risking increasing tension and making it more difficult to overcome the problem.
Emotional impact of enuresis in children
Enuresis can significantly affect a child’s self-esteem and emotional well-being. Often, those who go through this experience may feel inadequate or feel ashamed, especially if they perceive negative reactions from adults or peers.
Possible emotional consequences include:
- Guilt: the child may think he is responsible for what happened, even if it is an involuntary phenomenon.
- Shame and embarrassment: The fear that others will find out about the problem can lead to avoiding social situations, such as sleeping outside the home.
- Anxiety: the worry of not being able to control urination can increase the state of tension, especially when falling asleep.
It is essential that parents and caregivers maintain an understanding and reassuring attitude, avoiding reproaches or punishments that could accentuate the child’s discomfort.
The role of the family and effective communication
Management of enuresis may require active collaboration between all family members. A calm and non-judgmental environment can help improve the situation and help the child feel supported.
To promote effective communication it is useful to:
- Listen to the child’s needs: welcome his emotions without minimizing or playing down excessively.
- Avoid comparisons: every child has their own development times; comparing him to siblings or friends can increase pressure and feelings of inadequacy.
- Share information with your child’s caregivers: Maintaining consistency between parents, grandparents and teachers helps create a climate of trust and security.
An open and respectful dialogue allows the child to express his fears and feel understood, thus reducing the anxiety linked to enuresis.
When it may be useful to consult a specialist
In many cases, enuresis tends to resolve spontaneously with growth. However, it is advisable to consult a specialist when:
- The problem persists beyond 6-7 years: If bedwetting continues despite attempts to manage it at home, professional support may be helpful.
- Other symptoms are associated: such as pain, burning, changes in urinary habits, or marked emotional difficulties.
- The child experiences significant distress: if enuresis negatively affects your quality of life, social relationships or academic performance.
A consultation with a psychologist or pediatrician can help identify any underlying causes and define a personalized support path for the child and family.
Concrete help for the well-being of the little ones
Dealing with bedwetting can be challenging for both children and parents, but you don’t have to do it alone. An environment of listening, understanding and support can contribute positively to the growth and serenity of the whole family. If you feel the need for discussion or want professional help to better manage this delicate phase, Evidence Network psychologists are ready to accompany you step by step. Taking care of the emotions and well-being of the little ones is a first step towards a possible peaceful change. Start the questionnaire to find your psychologist online and find out how we can help you.
