Q&A: Taking the stress out of bedwetting
By psychologist Angie Willcocks
Dear Angie, I wondered if you could help me. My husband works in the mining in WA and we live in SA. Everytime Dad goes back to work she wets her bed for the first couple of nights. This has been happening for the past six months and while I have been patient with her, I am starting to get angry with her, which worries me. Her school teacher told me she had two accidents at school last week. She said she didn't know why she didn’t go to the toilet. This especially upset her, as a boy in her class starting teasing her, calling her names. I don’t know what to do as I am too embarrassed to talk to my friends - their kids all seem OK.
Hi Jaine, Bedwetting can be very stressful for the whole family, and in my experience the main stress it causes is from parents worrying "does this mean that my child is developing a psychological disorder?" Please be reassured that this is more than often NOT the case.
You may have already done some reading about bedwetting and may be aware that the medical term for bedwetting is enuresis. There are two sorts of enuresis: primary enuresis and secondary enuresis. Primary enuresis is when the child has never been consistently dry at night, and secondary enuresis is when the child has been consistently dry at night for at least six months and then starts wetting the bed again. You don’t mention how long your daughter was dry before this started happening, but I have assumed from your email that your daughter was dry up until about six months ago and that we're talking about secondary enuresis.
It is true that stress is more likely to be a factor in secondary enuresis. It is important to bear in mind however that there is a big difference between stress and a psychological disorder. Stress is a normal part of life that we call respond and react differently to. Some people cry more, others become irritable, some withdraw from interactions and others become sort of 'clingy'.
Although your daughter might well be stressed about her dad going away to work, the bedwetting does not mean that she is developing a psychological disorder. Stress can certainly contribute to bedwetting, but there are often other things going on as well, such as a physical predisposition to difficulties with bladder control. This physical predisposition has a strong genetic component – if either parent was a bedwetter and/or is prone to urinary tract infections the child is more likely to have difficulties with bedwetting.
Bedwetting is essentially a communication problem between the bladder and brain, and stress can interfere with this as it can with other bodily functions. Another way that stress can contribute to bedwetting is by affecting sleep patterns, so that if your daughter is having trouble getting to sleep, waking early or having a restless sleep, she may not be getting all the sleep she needs and sleep deprivation (even slight) can certainly contribute to bedwetting.
In my experience when bedwetting is a sign of stress there are more often than not other signs of stress as well. Did anything else change around the time that the bedwetting started? Has your daughter displaying other signs of stress over the past six months? Examples include: crying more than usual, clingy behaviour, withdrawal from friends, changes in eating habits, difficulty separating from you at school time (particularly if this has previously not been an issue), new difficulties with school work, and difficulties coping with 'normal' pressures of life (for example seeming to have over-the-top reactions to a simple stress such as not being able to find a school book, particularly if she is not usually like this). If your daughter is showing other signs of being stressed, my recommendation would be to see your GP for a referral to a psychologist who will be able to help you come up with some stress busting strategies for your daughter.
- Given that there is often a physical component to bedwetting (even if stress is a contributory factor) it is important to have your daughter thoroughly medically checked to see if there is an underlying physical component to her wetting that could be treated. The fact that your daughter also wet during the day time may indicate that there is a physical cause of her wetting, such as chronic constipation or a urinaty tract infection. In my experience parents and GPs alike assume a psychological cause of bedwetting before a physical one and I think this should be the other way around. If your GP is not helpful, ask for a referral to a paediatrician.
- Keep a diary of when 'accidents' happen. Although it can be a pain to do, a diary with all food, drinks and life events can be a great help in pinpointing triggers. Food sensitivities and allergies can play a part. Change in routines can play a part. Something as simple as a change in sleep habits can trigger bedwetting in children and a diary will help you pinpoint accurately what things are different when dad is away. I know that many FIFO families struggle with keeping routines and bedtimes the same when dad is home, and actually the change in routines can be part of the stress of having a FIFO lifestyle - not just dad being away.
- Have a think about whether there is anything practical that may be contributing to the problem, like a dark hallway to the toilet for example. Fear of the dark might be increased when dad is away. Many women do become more 'safety' conscious when their partner is away (checking that doors are locked etc more than they would if dad was home) and children do pick up on this and may get the unintended message "the house is less safe when dad's away". Of course this is never intentional, but many women have told me that they are more safety conscious with their partner away and I have even had a four year old tell me, "I don’t feel safe in my bed if there’s not a man in the house." (True story!) This comment absolutely stunned her mother who was a very capable woman and had no idea where her daughter got this idea from! Have a think about whether or not this may be a factor in your house and have a chat to your daughter in a casual way: "What is different when daddy is away?" or "Do you worry about different things when daddy is away?"
- If you think your daughter is stressed about missing her dad, there are a few little tips that can help her stay feeling connected to him even when he is away. When he is back next they could make or find a little token together that is small enough for her to have with her even when she’s at school. A small heart made out of card or a special stone are examples. Your daughter keeps this with her and whenever she touches it she knows that her dad is thinking of her too. Picture books such as The Invisible String and You, Me and the Rainbow are also very helpful as they talk about being connected to people even when we are not physically together with them.
- As hard as it is, take the low fuss approach to dealing with bedwetting on a practical level. Some parents find it helpful to make the bed up in a double layer (mattress protector, sheet, another mattress protector and then another sheet) so that if the bed is wet in the middle of the night the top layer can be whipped off and everybody can get back to sleep as quickly as possible. Change the sheets with a minimum of fuss and (as hard as it is!) try very hard not to make a big deal about the extra washing. Saying things like "it’s no problem I had washing to do anyway" goes a very, very long way to minimising the stress related to the actual bedwetting itself.
You mention that you are starting to get angry about the bedwetting. This is totally understandable! It is very important, however, that you deal with you own anger and frustration away from your daughter. You really do need to work hard to minimise any added stress for her and the guilt about bedwetting can last longer than the actual problem itself. The only adults who have ever spoken to me about bedwetting as a child are those whose parents were punishing or verbally abusive to their children about the bedwetting. Sorry to say that because I know it is very hard to be patient when you are stressed and worried but it is the truth. Please get some support from a trusted friend, family member or health professional if you are having trouble keeping your cool with your daughter.
I hope that all of this helps and I wish you and your daughter all the best! Thanks for your question, I’m sure it will be helpful for many other parents as bedwetting is a common problem and a common source of worry for children and parents.
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