Bed Wetting

Bed Wetting or Night time Incontinence or Nocturnal Enuresis

  

It is the commonest pediatric problem. About 10% of the 10year old kids bed wet occasionally. It is a developmental issue. Bed wetting is characterized by involuntary urination at night. It is more common in boys. Bed-wetting before age of 6-7 years is not a concern

It is the commonest pediatric problem. About 10% of the 10year old kids bed wet occasionally. It is a developmental issue. Bed wetting is characterized by involuntary urination at night. It is more common in boys.  Bed-wetting before age of 6-7 years is not a concern.

Causes for bedwetting

• Small bladder: If the child’s bladder is not developed enough to hold urine produced during the night.
  
• Inability to recognize full bladder: If the nerves supplying bladder are slow to mature cal lead to this.
  
• Hormonal imbalance: If there is decrease in anti diuretic hormone, to decrease night time urine production.
  
• Stress.
  
• Urinary tract infection.
  
• Sleep apnea.
  
• Type 1 diabetes mellitus.
  
• Chronic constipation: It can cause pressure on the bladder.
  

                                

When to seek medical help

• If the bedwetting continues after the age of seven or eight or occurring frequently.
  
• If the child was been dry for a while and suddenly starts wetting.
  
• If the bedwetting causes upsetting the child causing anger and frustration.
  
• If the bedwetting is associated with pain during urination, burning sensation while urinating.
  

Behavioral changes

• Limit liquid intake before bed time.
  
• Double voiding: Urinating at the beginning of the bed time and then just before falling asleep.
  
• Encourage the child to hold the urine for long time during day.
  

Moisture alarms - These are small, battery operated devices available at pharmacies. Connect to the moisture sensitive pad on child’s undergarment or pajamas. When the pas senses wetness, the alarm goes on and makes the child to wake, stop the urine and get into the toilet.

Medications

• Desmopressin: It increases the level of anti-diuretic hormone which slows the night time urine production. It makes the body to produce less urine at night.
  
• Antidepressants like Imipramine provide relief from bedwetting by changing the child’s sleeping and waking pattern. It also increases the amount of time a child can hold urine or reduce the amount of urine produced.
  
• Anticholinergics like oxybutynin help to reduce bladder contractions and increase bladder capacity.
  

Points to Remember

• Normal, healthy children may wet the bed.
  
• Bedwetting may be a sign of infection or other problems.
  
• Many children are dry at night by the time they are 5 years old. Others take longer to stay dry.
  
• Scolding and punishment do not help a child stop bedwetting.
  
• If your child is 7 or older and wets the bed more than two or three times a week, a doctor may be able to help.
  
• Treatments include bladder training, alarms, and medicines.
  
• Most children grow out of bedwetting naturally.