Affecting only 1% of bedwetters, it is very rare that medical issues are the main cause of the condition. However, sometimes there is an indirect connection. Most children will outgrow bedwetting spontaneously between ages 2-4; this period is called “the critical period”. If during this period the child is suffering from severe medical issues which require time and energy, he will lack the stability and normal routine in his life which is essential for the learning process. I had a patient, nine years old, who suffered from bedwetting. This child had a severe liver problem; for years he was often hospitalized and received complex treatments. Finally he had successful liver transplant. During the “critical period” he wasn’t able to learn how to activate the restraint mechanism. At age 9 he was beyond the “critical period” and therefore needed professional treatment in order to acquire the necessary skills.
The disturbances during the critical period aren’t necessarily of medical nature; any major issue during ages 2-4 can affect the child’s ability to become dry naturally including frequent geographical changes, marital problems that affect the child, child abuse, illness or death in the family, and separation, just to name a few.
These children simply missed the appropriate time for outgrowing bedwetting and will require a process of learning in the form of behavioral therapy in order to acquire those skills.