I recently spoke with the head of a kindergarten in Budapest, who explained that over half of the three-year-old children starting kindergarten do so without being toilet trained. Most of them wet themselves, and some soil their pants. You might say there's nothing particularly unusual about this, and it will likely pass. Sooner or later, that's probably the case. However, the 12–16-year-olds who still frequently don't wake up at night when they need to pee are embarrassed by what's happening. This sense of shame often turns into guilt, frustration, and self-esteem issues. When someone is not already toilet trained at four or five years old, no one can predict how long this condition will last. As a parent, you can prevent later problems by addressing the issue early.
Based on available data, bedwetting, also known as nocturnal enuresis, is a common issue among children. It affects 15-20% of five-year-olds and 5-10% of ten-year-olds. While the exact causes of bedwetting are not entirely clear, research suggests that the nervous system plays a crucial role.
Both components of the nervous system, the central and peripheral, are involved in regulating bladder function. The central nervous system (CNS), which includes the brain and spinal cord, controls the overall functioning of the body, including the bladder. The peripheral nervous system, consisting of nerves, is responsible for transmitting signals from the CNS and relaying signals from the external environment and organs to the CNS for processing and interpretation.
During sleep, the central nervous system sends signals to the bladder muscles to relax, allowing the bladder to expand and retain urine. Simultaneously, it instructs the sphincter muscles of the bladder to maintain appropriate tone, preventing urine from escaping. In children struggling with bedwetting, these functions may not work properly, resulting in involuntary urination during sleep.
Various factors can disrupt the normal functioning of the nervous system and contribute to bedwetting (or even daytime incontinence). For example, some children may have an oversensitive bladder or a small bladder capacity. In others, the nervous system may not produce enough of the hormone responsible for water reabsorption. And others may experience the problem because their nervous system is not yet mature enough to regulate bladder function.
What does this last sentence mean?
For the nervous system to function properly, it is necessary to process incoming signals as accurately as possible. This generates an appropriate response to the signals. In the context of toilet training, this means that when the nervous system senses that the bladder is full, it literally and figuratively “wakes up” the person, signalling them to “go to the bathroom.”
For this process to go smoothly, it is essential to precisely adjust muscle tone and accurately detect changes in tone. The adjustment of muscle tone always depends on the position of our head in space. It matters whether we are sitting, standing, lying down, rolling, or spinning. The vestibular system or organ of balance in our inner ear detects the movement and spatial position of our head. If this organ functions incorrectly or is immature, imprecise signals are sent to the central nervous system (CNS). As a result, our brain cannot properly adjust our muscle tone.
The vestibular system also plays a significant role in perceiving the condition of muscles and tendons. Therefore, if this organ does not work perfectly, it can cause issues not only with regulating bladder muscle tone but also with sensing bladder fullness.
Studies have shown that in children suffering from bedwetting, the muscles controlling the bladder, known as the detrusor muscle, and the sphincter muscles of the urethra have reduced muscle tone (hypotonia). Reduced muscle tone can make it difficult for the bladder to retain urine, and the urethral sphincter may fail to prevent urine leakage. Additionally, in some cases, the detrusor muscle may overreact, causing excessive or strong contractions of the bladder, leading to involuntary urination.
Why does the vestibular system or organ of balance not mature?
One of the most common explanations is related to primitive reflexes. If a baby's muscle tone was too rigid or hypotonic during infancy, the quantity and quality of the movements triggered by the reflexes were not appropriate. These reflexes are responsible not only for triggering the appropriate stimuli through head movement, thus maturing the semicircular canals found in the inner ear, but also these reflexes stimulate certain areas of the prefrontal cortex of the brain.
This part of the brain is responsible for executive functions such as decision-making, impulse control, and attention, but it also plays a role in the voluntary regulation of urination. Studies have shown that in children suffering from bedwetting, there is a decrease in prefrontal cortex activity during sleep, which can contribute to a lack of control over bladder function.
The presence of primitive reflexes beyond the age of three is a SYMPTOM indicating that the cerebral cortex is not mature enough and still needs the stimuli generated by infantile reflexes. Therefore, the cortex does not inhibit the functioning of these reflexes, allowing them to "stay present."
For various reasons, many primitive reflexes often do not get inhibited. The specific problems caused by the persistence of these reflexes largely depend on which combination of primitive reflexes persists.
Concerning urinary retention, the most frequently persistent reflexes are the following: the asymmetric tonic neck reflex (ATNR), the hip-lumbar reflex (Galant), the tonic labyrinthine reflex (forward and backward), and the parachute reflex. If someone regularly performs appropriate exercises to facilitate the inhibition of these reflexes, their bedwetting problem is almost always resolved.
Naturally, in cases of urinary retention issues, it is essential to first rule out any hormonal or physical causes of the problem. If these are not the cause, then it’s time to start exercises to mature the nervous system.
Readers can read more in the Bedwetting chapter of my book. There, you can also find the most commonly used and recommended exercises for solving this issue.
You can also use the video package I created containing twelve specially compiled exercises to alleviate the problems caused by bedwetting.
I recommend using these exercises to achieve dry and calm nights!