In addition, if we accept the fact that most children who bed wet can control their bladder by day, we should ask, how can a child control her bladder by day and not by night? To answer this latter question, consider the three skills children must master in order to achieve day time bladder control:
- The ability to sense when a bladder contraction is imminent.
- The ability to voluntary inhibit the bladder muscle from contracting.
- The ability to contract their urine holding muscle (the bladder sphincter, the one we rely on after the movie has ended and the theater restroom is packed)
The key word here are intuitive functions of sensation and volition. If we agree that the common thread of these functions is awareness, then we conclude that children who bed wet sleep so deeply that they may not have the skills to perform these functions.
Example
Lets take the case of a boy name Tommy, who bed wets occasionally. During sleep, Tommy can sense an impending bladder contraction, inhibit the contraction, and possibly actively tighten his bladder sphincter, and so stay dry. Alternatively, if Tommy's bladder is very full and he is not sleeping very deeply, then he may arouse himself, go to the toilet and urinate, and return to bed. The key word here is arouse. Children who do not bed wet can wake themselves to use the potty at night.
Consider the differences in the following scenarios:
Saturday. Tommy, at his own birthday party in the afternoon, eats his fill of cake and over drinks soda and juice. After dinner he continues to celebrate with cake and soda with his family. That night he gets up a few time to use the potty but otherwise he sleeps soundly in a dry bed.
Why? Despite all the liquids he consumed, Tommy stayed dry because he has acquire the ability to wake himself when he senses that his bladder is full (if he's not sleeping too deeply). Tommy went to bed at nine and then awakened to use the potty at typical intervals of time, first around eleven, then again at two, and finally again at five.
Monday. After school, Tommy plays a basketball game in the afternoon and comes home exhausted. After rushing through dinner, he does his homework and goes off to bed. At two in the mourning, Tommy wets his bed.
Why? The stress of the game? Fear of poor grade in school? No. Probably because he went to bed so over tired that he slept too deeply to sense his bladder's fullness.
Sunday. Tommy plays the last 4 minutes of each quarter on the playoff game. Between quarters, he gulps down a cans and cans of sports drinks. Tommy's team plays poorly and ultimately loses. That night Tommy bed wets.
Why? Ah-ha, you say, he was upset! Perhaps, but a stronger possibility is a combination of factors, He was overtired, so he slept too deeply, and he drank too much, thus overloading his limited ability to wake up to urinate.
Tommy's case illustrates an important principal, whether a children bed wets only occasionally (like Tommy) or routinely, The same causes are likely to blame. For all children who bed wet, we need to consider what circumstances may impede their normal process of outgrowing their bedwetting. Most children bed wet because they have not yet developed the control to coordinate the functions of inhibiting a bladder contraction, tightening the bladder sphincter, and waking up enough to get himself to the potty on time.
If the child also has to deal with small functional bladder capacity or sensitivity to common foods or beverages, or bowel so sluggish that they press on his bladder, then maintaining urinary control becomes even harder to do. On top of these complications, if he's family or friends make him feel ashamed, then achieving dryness becomes an enormous task.
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