Some families report that bedwetting in their children started or increased after a stressful occurrence. We do know that these children can subsequently regain dryness after their life has normalized and by using some of the same methods used by children with primary bedwetting and no stressful events.
An interesting study has examined whether early stressful events (before age 4) were associated with increased bedwetting from 4 to 9 years. This prospective study of over 8,000 children in England looked at stressful events, such as family breakdown, moving, accidents, separation from mother, etc. in the first 4 years of life. The results were adjusted for maternal depression, socioeconomic position, and maternal rating of the child’s developmental level at 18 months.
The development of nighttime bladder control was broken into several categories:
Normative development – low probability of bedwetting at any point
Infrequent delayed – delayed attainment of nighttime bladder control but decreased probability of infrequent bedwetting from 4 to 9 years
Infrequent persistent – infrequent bedwetting from 4 to 9 years
Frequent delayed – frequent bedwetting at 4 years, which became infrequent at 6-9 years
Frequent persistent – bedwetting at least twice a week from 4-9 years
It was found that the total number of stressful events during early childhood, rather than any single event, was important in determining the risk for subsequent bedwetting. The association with stressful events was strongest for the frequent persistent bedwetting group.
One could ask whether the cause of bedwetting in the frequent persistent group has a different etiology. It could be speculated that the less severe categories are due to a maturational delay but the persistent categories are due to other causes.
Family stress has also been found to be an important prognostic factor in the treatment of children with enuresis. There are potential benefits to preventing or reducing sources of stress to promote healthy development of nighttime dryness.