Difficulties with bladder control

Difficulties with bladder controlcan be due to a problem called Enuresis. Children with enuresis are five years old or older and often pee in their clothes or bed. This happens by accident—it is not on purpose, nor is it laziness or disobedience—and can occur during the day or night.

Some kids with enuresis do not notice when they need to use the bathroom. Others may realize they need to pee but get distracted and forget until it’s too late. Kids with enuresis at night usually sleep very deeply and do not wake up when they wet the bed.

A child is more likely to have urinary accidents if their parents had this problem (especially the father), if they experience stressful situations, or if their toilet training was delayed or inconsistent. Boys are more likely to have enuresis at night, while girls are more likely to have it during the day.

What is typical?

Urinary accidents are common in nursery and preschool years since most children are toilet trained by about age 3. Here’s what you might expect to see at different ages:

• By age 3: Most children are toilet trained but might still have accidents.
• By age 5: Children usually have better control but might still have accidents, especially during stressful times.

Young kids, especially those younger than 5 and still toilet training, may have accidents during school. They are still learning to understand their body’s signals and might wait too long to use the bathroom.

When should I be concerned?

Even toilet-trained children have occasional accidents after training. These accidents can happen due to stressful events at home or school, but they should not last long.

Caregivers should worry if their child regularly (like once a week) pees in their clothes during the day or wets their bed at night past age 5, or if a child starts having accidents again after being toilet trained, even if they are younger than 5.

These episodes can happen for different reasons, including:

• Development: Some children have slower development of the brain areas that control the bladder.
• Deep sleep: Others may sleep so deeply that they do not notice the need to urinate.
• Emotional factors: Changes in routine, school stress, or the arrival of a new sibling can also contribute.
• Physical causes: Urinary infections, constipation, or a family history of enuresis can be factors.

What can I do to help?

As a caregiver, you can try these things to help your child with enuresis:

1. Talk to your child.Ask simple questions to understand if stress might be causing enuresis.
2. Create a calendar.Mark “dry and sunny” nights or “wet and rainy” nights, with rewards for dry nights.
3. Use moisture alarms.These alarms can wake your child if they start wetting the bed, but it might take a few weeks to work.
4. Limit drinks at night.Give your child their last drink an hour before bed. Remind them to use the toilet right before bed.
5. Schedule toilet visits.Wake your child once or twice during the night to use the bathroom.
6. Encourage bathroom use.Have your child go to the bathroom more often during the day.
7. Stay positive.Be supportive and kind if an enuresis episode occurs. Never scold or punish. Let your child know it was just an accident and that you are there to support them.

What kind of professional support can I seek out?

Sometimes, caregivers might feel embarrassed, guilty, or angry if their child has enuresis. If you are concerned, support and guidance are available. Talk to your child’s doctor about your worries. Pediatriciansor family doctorscan help and may refer you to specialists.

A doctor will diagnose enuresis only if the child is at least five years old. For a diagnosis, a doctor will consider if:

• The child pees in their clothes or bed.
• The symptoms occur at least twice a week for at least three months, or if it causes problems for the child in school or with friends.

The doctor will check the child for medical problems like urinary tract infectionsor diabetes. They might also prescribe medicines to reduce enuresis. Remember to avoid scolding or comparing your child to others, as enuresis is not the child’s fault.

You can also find free support through the Unified Health System (SUS). Care often begins at your local Basic Health Unit (UBS).