Enuresis (Bedwetting) In Children – Causes And Treatment

Children under 4 years, often wet their beds as they still didn't attain the ability of bladder control. Children learn bladder control at various ages. However, most children attain bladder control (to some extent) by 4 years of age. Daytime control is generally accomplished first, while nighttime control comes later. By age 5 or 6 most children can stay dry through the night. However, between the ages of 6 and 7, bed-wetting remains a problem for some children. Even though not a serious medical issue, bedwetting can be a very upsetting situation for older children and have a far-reaching impact on the child (as it can even interfere with a child's socialization ability) and often lead to significant stress within the family.

What is Enuresis?

Enuresis refers to the unintentional passage of urine, whether in the clothing during the day or in bed at night. When this happens during the night, it is called bedwetting. The tag of bedwetting goes with the child older than five years old, wetting the bed at least a couple of times per week, over at least three months.

What are the types of bed wetting?

There are two types of bedwetting:

# Primary bed-wetting:

Primary bed-wetting refers to bed-wetting that has been continuing from early childhood without a break. A child with primary bed-wetting has never been experienced a dry night for any significant length of time.

The primary bed-wetting more often points the nervous system that is not fully evolved. Therefore the child may not be able to recognize the feeling of the full bladder during sleep.

Causes:

One or a combination of the following can bring about primary bed-wetting in children:

Reduced bladder capacity: Some children may have a smaller bladder volume. Therefore, their bladders will not be able to hold all of their urine until morning.

Deep sleeping: Many children who wet the bed are found to sleep deep and sound during the night. Therefore, they will not wake up to pass the urine.

Increased urine production during night: As a rule, during night, the brain releases a hormone called vasopressin. This hormone urges the body to reabsorb the water from the urine, back to the bloodstream. This decrease the urine production during the night. However, some children may not produce enough of this hormone. Those children produce large amount of urine during the evening and night hours, resulting in bed wetting.

Inability to recognize a full bladder: If the nerves that control the bladder are not fully matured, a full bladder may go unrecognized by the child resulting in bed wetting.

Unhealthy daytime toilet habit: Many children exhibits a habit of overlooking the urge to urinate and put off urinating as long as they possibly can. This can result in bed-wetting.

# Secondary bed-wetting:

Secondary bed-wetting refers to the bed wetting that starts all over again after the child has gone through a significant period (at least six months)of ‘dry' nights. Unlike the primary bed wetting, secondary bed-wetting can be an indication of an underlying medical or emotional problem. More often, the child experiencing secondary bed-wetting may encounter daytime wetting as well.

Causes:

Common causes of secondary bed-wetting include:

Urinary tract infection: This infection can make it difficult for your child to control the urge to urinate. This often leads to daytime accidents and bed wetting. Frequent urination, red or pink urine and pain during urination are other symptoms

Structural abnormality: A deformity in the organs, muscles, or nerves that is involved in the process of urination can bring about bed-wetting in children.

Diabetes: For a child who starts bed-wetting all over again after significant dry nights can be the first sign of diabetes. Watch out for other signs of diabetes like passing large amounts of urine, increased thirst, fatigue and inexplicable weight loss

Sleep apnea: Sometimes bed-wetting can be a sign of obstructive sleep apnea, a condition in which the child's breathing is interrupted during sleep. It is also characterized by markedly loud snoring and choking while asleep, daytime drowsiness, etc.

Constipation: Constipation results in lots of stool in the rectum. This will put extra pressure on the bladder and result in bed wetting before the bladder is full.   Constipation also put a toll on the holding capacity and draining capacity of the bladder. More often,  by treating constipation, bed-wetting also disappears.

Emotional stress: Stressful events such as fighting parents, new baby, starting a new school, or sleeping away from home, anything that makes the child insecure may trigger bed-wetting. Children who are being physically or sexually abused are also found to start bed wetting.

How is enuresis treated?

Enuresis is not a surgically treated condition. In fact, treatment usually is not recommended for children younger than 6 or 7 years. However, if the child is older than 7, and continue to wet the bed or start to wet the bed suddenly, it is recommended to find out the underlying cause and treatment. Treatment options will vary depending on the child's age, the frequency of wetting, and the underlying cause.

Options for treating bed-wetting may include :

  • Limiting the child's fluid intake after dinner
  • Encourage or lift the child and take them to the bathroom at least two times during night
  • Using a moisture alarm that goes off the wetness sensor detects urine.
  • Medication to bring down the nighttime urine production an to increase the bladder capacity. However, medication opts as a last resort.
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