| So, what really causes bedwetting? | | | | they are to wake up. Parents like us think that |
| The causes are not simple and differ between | | | | our child is sleeping deeply, when in fact ,they are |
| children. It is certainly true to say that the most | | | | just difficult to wake up. |
| likely cause is a combination of causes. Below is a | | | | So they sleep deeply, in the sense that they are |
| list of possible causes, all of which have a basis in | | | | difficult to arouse from sleep, but not in the sense |
| scientific evidence. | | | | that they sleep any differently from other |
| | | | children. In fact, some studies show that they |
| 1. The child makes too much urine at night | | | | have marginally lighter sleep than non bedwetting |
| 2. They have small bladders | | | | children but are still more difficult to arouse. |
| 3. They have an inability to wake up from deep | | | | They have a bladder dysfunction. |
| sleep | | | | Some studies have found that the muscle at the |
| 4. They have bladder dysfunction | | | | mouth of the bladder, which is responsible for |
| 5. They have a brain/bladder communication issue | | | | pushing the urine out of the bladder (the detrusor |
| 6. There is a hereditary element to bed wetting | | | | muscle), is hyperactive at night. This means that |
| You do not need to know what the specific cause | | | | the bladder is active all night ,and the brain is |
| of your child's bedwetting is to get rid of it. A | | | | getting signals all night which it doesn't respond to, |
| successful approach treats as many of the | | | | leading to disturbed sleep. It seems that the body |
| possible causes as possible. | | | | overcompensates for this constant disturbance |
| The causes are, as you will see, difficult to | | | | and becomes difficult to arouse. |
| separate out as they are mostly linked to each | | | | There is a delay in the brain/bladder connection. |
| other and children have a combination of these | | | | Over time, children develop a connection between |
| causes. | | | | their bladder being full and the need for the pelvic |
| The child makes too much urine at night. | | | | floor to stay shut so that they don't wet |
| In the scientific literature, this is called nocturnal | | | | themselves at night. |
| polyuria. | | | | It seems that some children are slower to make |
| As we grow older, usually at about 3-4 years, our | | | | this connection, and the brain does not get the |
| body starts to produce a hormone that stops us | | | | message to keep the urine in the bladder. Some |
| from producing so much urine at night. The | | | | children are dry at night from as early as two |
| hormone is called Anti-diuretic hormone (ADH), | | | | years old and so have developed this connection |
| also referred to as arginine vasopressin (AVP). It | | | | early. |
| means that we produce about half our day-time | | | | Our central nervous system is responsible for all |
| amount at night. Some bed-wetters do not | | | | the brain/body connections, and it is thought that |
| produce enough of this hormone, meaning that | | | | some children have a developmental delay in |
| they continue to produce the same amount of | | | | some parts of it. |
| urine in the day as at night. At the very least, this | | | | Also, if your bladder is overactive and/or you |
| means that they would be getting up to empty | | | | have a sleep arousal problem, your brain won't |
| their bladders if indeed they woke up to do so. It | | | | get the message either. This cause is also a |
| may be that they take longer in their | | | | "which came first - the chicken or the egg" |
| development to start producing this hormone than | | | | category of cause. |
| others. | | | | It is hereditary. |
| Their bladders are small. | | | | Several genes have now been isolated for |
| Some studies have shown that bedwetting | | | | bedwetting, and we know that you have a |
| children have bladders with less than half the | | | | greatly increased chance of wetting the bed if |
| capacity of children who are dry. Why would this | | | | there is a family history of it. |
| be? One explanation is that if your bladder is | | | | It is not clear what exactly is inherited. Is it the |
| emptying at random during the night, it never | | | | sleep arousal problem, the bladder dysfunction, |
| gets a chance to grow. Your brain doesn't get the | | | | the lack of ADH, or the lack of brain/bladder |
| message to hold on to the urine, and so the | | | | connection? |
| bladder empties and stays small. Restricting fluids | | | | Of course, we can't do much about the fact that |
| would also keep the bladder small, as would not | | | | it can be inherited, but it is interesting to know. If |
| drinking enough fluids in the day and lifting at night. | | | | one waits until the child grows out of bed wetting, |
| They have a sleep disorder, which is an inability to | | | | it seems that they stop wetting at a similar age |
| wake up from deep sleep. | | | | to their relation. |
| This is the research that I found most interesting. | | | | How do I know what the cause is for my child? |
| When I spoke to other mothers and doctors | | | | Simply, unless we subject our child to scientific |
| about bedwetting, the majority of them told me | | | | experimentation, we are unlikely to know which |
| that their child is a "very deep sleeper." It seems | | | | combination is affecting our specific child. Frankly, |
| to be very common amongst bedwetting children. | | | | scientists do not have definitive answers yet and |
| In fact, all the most recent research shows that | | | | you do not need to know the exact cause for |
| bedwetting children have the same pattern of | | | | your child for the treatment to be successful. |
| sleep (in that, it shows the same variance and | | | | This is why it is essential to address as many of |
| individuality) as non-bedwetting children and that | | | | the causes as possible when we decide that it is |
| the sleep disorder is actually about how difficult | | | | time for our child to be dry. |