Bed-wetting

 

Bedwetting is a phenomenon where a person urinates involuntarily. This is considered a medical condition in children more than 5 years of age. This may occur during the day or night time. It is known as diurnal enuresis, when it occurs in the day time and nocturnal enuresis, when it occurs in the night time. Among infants due to a reflex, urination is spontaneous. As the children, grow by the age of 3 years, they begin to develop control over their urination. This is completed by age 4.

There are two types of bedwetting:

1. Primary enuresis where children continue to wet their beds at night. In this case, the child’s brain has not yet learned to control the bladder.

2. Secondary enuresis is a condition where children who have no symptoms of bedwetting for about 6 months, relapse and begin to wet their beds again. This may occur after being toilet trained. Stressful conditions are known to precipitate secondary enuresis.

 

 

It is seen that about 15% of all normal children wet their beds at night at about 5 years of age. It is 50% more common in boys than in girls. Girls tend to be dry at about age 2. It is seen that about 80% of all enuresis happens only at night. The underlying condition of emotional stress can lead to about 25% increase in secondary enuresis among those children who are dry at night by 12 years of age. Day time enuresis relapses in only about 10% of children. By age 15, about 99% of all cases are dry.

 

 

Common causes and risk factors are:

1. Among young children, this maybe a normal phenomenon physiologically and psychologically. The underlying cause is as yet unknown in some cases.

2. Reduced capacity of the bladder by 50%.

3. Sleep disturbances where the child falls asleep too deeply or does not awaken.

4. Delayed development

5. Genetic factors

6. Infection of urinary tract

7. Other conditions such as small size of the bladder, hormonal imbalances, constipation, and congenital defects of the urinary tract.

 

 

The main symptom of concern is urination at any time during the night or day.

 

 

1. A complete history is to be taken to get the details of bedwetting. A diary may be maintained to identify episodes.

2. Physical examination maybe conducted.

3. Urinalysis or examination of the urine maybe done to rule out the presence of diabetes or other infections.

 

 

1. The child must be taught to regularly use the bathroom during the day and evening and not to hold urine. Also, the child should also be encouraged to go to the bathroom before going to sleep.

2. The fluid intake should be restricted just before sleep time. Alarms are available which awaken the child or the parent when the child begins to urinate so the child can get up and use the bathroom.

3. Treatment for bedwetting with medications is not encouraged before age 7 because it is seen to be less successful.

4. If the condition does not resolve, anticholinergic drugs are shown to be only 5% to 40% effective. The drug called desmopressin is sometimes prescribed to treat bedwetting. At times tricyclic antidepressants may be useful when other treatments fail.

 

 

There are no known complications with bedwetting especially if the child does not have any physical illnesses alongside. If it is due to underlying causes such as urinary tract infections or neurological conditions, they need to be treated to prevent further complications due to the infection or neurological abnormalities themselves.

 

 

The child should be encouraged to use the bathroom at regular and take responsibility which can help prevent bedwetting.