Bedwetting or enuresis means that a child passes urine without his knowledge when he is sleeping. Night time bedwetting is specifically called Nocturnal Enuresis.
Most children gain daytime bladder control by 3 years of age, while night time control takes a little longer and the child is dry at night by about 4-5 years of age. Majority of children(85%) achieve complete control of bladder (day and night time) by 5 years of age. A child is considered to have bed wetting if he keeps on passing urine in bed at least 2 times a month after the age of 5 years. Bed wetting reduces to 5% at 10 years and 1% at 15 years. More boys are affected than girls.
It is classified in to 2 types (A) Primary and (B) Secondary. In primary nocturnal enuresis, the child has never been dry at night, while in secondary type, the child has been dry at night for at least 6 months at a stretch, and has started to wet the bed again.
Primary nocturnal enuresis-This is the most common type and is caused by many factors which include developmental(as children grow older they learn to gain control over bladder contractions), genetic and hormonal (this night time rise in ADH does not occur as expected), small bladder capacity,usually deep sleeper,constipation and ADHD may be associated with it.
The likelihood of a child having nocturnal enuresis is around 50% if one parent and 75% if both parents had wet the bed when they were younger. If none of the parents had wet the bed as a child, the chances that a child will wet the bed drops to 15%.
Secondary nocturnal enuresis- It can be secondary to some underlying cause, like stress in the family, parents divorce, new baby in the family or examination failure,sexual abuse.Wetting the undergarments after 3yrs should be investigated.
Investigations- child may need urine examination, blood tests, ultrasound and special x-rays in those cases who have neurological problems or for those who pass urine in undergarments while awake, or have urgency, frequency, dribbling or difficulty in passing urine.
General advice is given to all enuretic children, but active treatment is not required before the age of 7 yrs.Never punish, criticize or blame the child.
Limit fluid intake at night and avoid caffeinated drinks and milk.
The main modalities of treatment are
a. Motivational therapy -in which we reward and keep a chart
b. Behaviour therapy -requires supportive parents, a motivated child and a doctor with patience
c.Use of alarms-device consists of a small sensor attached to the child’s the underwear .When the child starts wetting the bed in his sleep, the sensors are activated and the alarm starts ringing
d. Drugs-alone for initial treatment of nocturnal enuresis are never preferred and are usually not considered before the age of 8 years. There are mainly two drugs
(a) Desmopressin (DDAVP) and (b) Imipramine. Both these drugs should be taken under doctor supervision
BedWetting In Children - Whom to Consult ?
Child BedWetting Treatment Specialist Doctor in Delhi, India ( Preferably a Pediatric Nephrologist ) needs to be consulted if the parents and child are depressed or frustrated,even after 7 years child is not dry overnight, if the child has urinary symptoms like urgency, frequency, hesistancy secondary eneuresis is there.
Dr. Amit Agarwal
Consultant Paediatric Nephrologist in New Delhi
Madhukar Rainbow Hospital, Delhi, INDIA
