Bed wetting, also called nocturnal enuresis affects many school-age children and even some teenagers.
It is not a very serious health problem, and children usually outgrow it but still, it can be very upsetting for children and their parents.
Around 20% of children still bed wets at age 5, and up to 10% still at age 7. By the late teens, the estimated rate of bed wetting is between 1-3% of children.
It is said to be two to three times more common in boys than girls.
There are two types of nocturnal enuresis:
1. Primary enuresis: This is when a child has never had bladder control at night and has always wet the bed. This is much more common.
2. Secondary enuresis: This occurs when a child did have bladder control at night for a period of at least 6months, but lost that control and now bed wets again.
Causes
Although not completely understood, bed wetting is thought to occur because of a delay in the development in at least one of the following three areas at nighttime:
1. Bladder: Less space in the bladder at night
2. Kidney: More urine is made at night
3. Brain: Unable to wake up during sleep
In babies and toddlers, links between the brain and the bladder have not fully formed, so the bladder releases urine whenever it feels full.
As children get older, the links between the brain and bladder develop, so the child can control when the bladder empties and this usually develops during the daytime first; though it usually takes more time before it happens at night.
Other risk factors include:
1. Genetics: It is said that if one parent bed wets after 5years old, their children may have the same problem about 40% of the time. If both parents bed wets as the children, then each of their children would have a more likely 70% chance of bed wetting.
2. Stress
3. Deep sleep
4. Obstructive sleep apnea/ Snoring
5. Constipation
6. Bladder or kidney disease
7. Neurologic disease
8. Other disease conditions like diabetes, attention-deficit hyperactivity disorder
Treatment
Its treatment depends first on if it is caused by stress, which would need to be managed first.
In general, children who take an active part in their treatment plan have a better chance of decreasing or stopping it.
Bed wetting alarms:
Research shows that about half of children who properly use these alarms will stay dry at night after a few weeks. These alarms vibrate when a child’s underwear gets wet.
Overtime, the brain is trained to associate the feeling of needing to urinate with the alarm going off, and getting up to go to the bathroom.
This therapy requires active participation of an adult to ensure the child fully wakes up and goes to the bathroom when the alarm goes off.
Medications:
There are only two drugs that have been approved for bedwetting treatment- Imipramine and Desmopressin.
It is important to note that bed wetting usually returns once the drugs are stopped, unless the child has ‘grown out’ of bed wetting.
It is also important to note that children with an abnormal EKG should not be given imipramine and they should not drink any fluids after taking desmopressin to decrease the risk of electrolyte imbalance.
An additional drug, oxybutynin, has been shown to be helpful, especially in persons who do not respond to desmopressin alone and can be given in combination with it.
Lifestyle Modifications to Reduce Bed wetting
1. Reduce the intake of foods or drinks with caffeine and avoid salty snacks and sugary drinks, especially at night.
2. Encourage your child to go the bathroom regularly during the day, every 2-3hours and just before going to bed.
3. Encourage double voiding before bed.
4. Wake your child only once during night time to urinate, if needed.
5. For sleepovers and overnight camps, you can consider sending your child with disposable underpants and boxer shorts over them.
Some herbs are thought to be good for bed wetting, such as, jumper, lobelia, marshmallow root, parsley root, and uva ursi.
The Emotional Impact of Bed wetting
Bed wetting can have an emotional impact on both children and their families.
Children can get anxious, feel embarrassed, or develop low self-esteem and this can affect their quality of life, relationships, and schoolwork.
Siblings of the affected child may have to sleep in separate rooms or be woken up when the parent or bed wetting alarm wakes the child.
Family members may have the extra work of washing the dirty sheets and clothes.
The following tips can help cushion the emotional impact:
1. Do not blame the child; offer support and not punishment for wet nights.
2. Be honest with your child about what is going on.
3. Be sensitive to your child’s feelings.
4. Let your child help: involve him/her in the process.
5. Set a no-teasing rule in your family.
6. Be aware of your child’s bowel habits.
A note to Remember
Bed wetting almost always disappear on its own.
Most children will grow out of it by their late teenage years or sooner. Secondary enuresis may disappear when the cause is found. It is either treated or it gets better on its own.
If it has not stopped in the late teenage years, ensure your child sees a doctor.
Also remember that bed wetting is not your child’s fault or under his control. Family members and friends should not shame or punish the affected child.
Dr. Favvy
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Disclaimer
The information on this blog is for educational purposes only.
It should not be used as a substitute for the medical care and advise of your pediatrician
Always consult your pharmacist before giving your child any drug..
nice post
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