Bed Wetting

Wetting the bed at night is referred to as 'nocturnal enuresis' or 'bed wetting'. It is common in children, usually between 2 to 4 yearsof age, after the child has completed her toilet training. Bed wetting occurs 2 to 3 times per week early in this period and reduces gradually. It usually comes to a stop when the child is around five years old. In some children, this continues past the age of five, even up to adolescent stage. This affects one in every ten children above five years of age. This is less common in girls than in boys of this age-group, because in girls, control over nervous, muscular systems, and awakening response to the urge of full bladder develops more rapidly than that in boys.

Causes

• Hereditary - In families with a history of bed wetting or sleep disorders, chances of a child being affected by the problem of bed wetting is greater. If either one of his parents had this problem, the child has about 50 percent chance of bed wetting. Chances increase to nearly 80 percent if both the parents had this problem when they were children. Scientists have found that bed wetting is linked with certain genes. The cause being hereditary, the child stops bed wetting at the same age when it stopped for his parents.
• Physical immaturity - Bed wetting occurs because the child's bladder is not developed to be large enough to hold the urine output all through the night. Another reason is because response to the urge of full bladder by way of awakening in the night is not yet developed in the child.
• Medical problems - Diabetes, constipation, urinary-tract infection, pin worms and kidney failure may cause bed wetting. Problems in the spinal cord and problems in the urethral valves can be other reasons for bed wetting.
• Slow nervous and muscular control - Slow development of voluntary control of the brain and control of the muscles of the bladder cause bed wetting.
• Hormone function - A hormone called anti-diuretic hormone that slows down the production of urine is normally produced by the body. This hormone production increases at night, which slows down the urine-production and thereby lowers the need to urinate. Inadequacy of this hormone production at night leads to more production of urine and thereby overfilling the bladder. If the child does not respond to the urge of full bladder by awakening, then bed wetting occurs.
• External stress - If a child starts bed wetting suddenly after totally dry nights previously for about six months, it may be due to some kind of external stress. The stress may be due to a changed location, stressful situation between parents, parenting being shared with a new sibling, scolding from parents, unfamiliar social situations, etc.

How does bed wetting affect children?

Children who wet their bed at night may feel embarrassed to face people, including his family members and friends. They tend to feel ashamed and inferior to other normal children, for they feel they are not able to have control over a bodily action that they think is simple. They worry about being ridiculed by friends, older siblings, sometimes even by a younger one if he is has stopped bed wetting, and being abused by elders of the family. Children with this problem also tend to keep themselves away from social activities which require them to get through sleepovers and journeys overnight. Punishing or teasing will not help cure the problem, instead it will only add insult to injury, and make it difficult for them to stop the habit.

How can you help your child overcome bed wetting?

Help your child get over the embarrassment by sharing with her the causes of bed wetting - (sound sleep and delayed development of the bladder), thus making her understand that it is not her fault. If you were a bed wetter, share this information with her and also tell her she is not the only one who bed wets. There are so many children of her age and even older children, with the same problem. These will definitely help her not to feel guilty about her so-called shameful behaviour.

Generally, children outgrow their bed wetting habit. Increased bladder capacity and strengthening of bladder muscles occur as they grow in age. The message from the brain to the bladder is received with more alertness, as their sleep pattern changes to one of less deep sleep.

Bed wetting can be stopped by behavioral training and medications if the doctor diagnoses any physical abnormality.

Behavioural Trainings

Behavioural training is the best method to deal with a child's bed wetting. Though you may not get immediate results, you can be sure about improvements which are not time-limited, but will continue throughout.

Retention Control Training

Train the child to control urinating during daytime. Give your child lots of fluids, then make him withhold urine for a few minutes to begin with, then increase the time period of withholding. This is a good exercise to increase the capacity of the bladder and to strengthen the muscles that hold back urination. This kind of retention control exercise can be practised only after consultation with the doctor.

Waking Up at Night

Wake your child up 1 or 2 times during the night. Make him walk to the bathroom to urinate and walk back to his bed. This is a helpful exercise to stop bed wetting.

Moisture Alarms

It is a useful and successful treatment for bed wetting. The alarm is attached to the bed clothing and turns on when the child begins to wet the bed. It wakes up the child who can be asked to go to the toilet to finish urinating and go to sleep again. This helps in gradual conditioning of the brain to respond to messages from the bladder during sleep.

Medical Treatment

Medications cannot be said to be effective over behaviour training. Medications are effective as long as they are continued. Once you stop the medicine, there is the possibility of bed wetting continuing. The medicines can cause serious side effects too. Doctors may prescribe either of two drugs imipramine and desmopressin acetate if the child shows any problem physically. The first one is administered to improve the functioning of the bladder muscles or to improve the child's sleeping pattern. The second one does the hormonal function of reducing the production of urine, thereby preventing overfilling of child's bladder during sleep. Given their effectiveness is only with continued use and the side effects they cause, medical treatment cannot be considered the best treatment for bed wetting.

Other Precautionary Measures

• Limit your child's intake of fluids in the hours before he goes to bed.
• Ask your child to urinate a few times, during the hour before going to bed.
• Dress him up with warm clothes in cold weather. When the temperature lowers, it increases the chances of bed wetting.
• Do not give your child drinks containing caffeine (coffee or colas).
• Leave a night light on, so that your child can easily reach the bathroom at night.

When to consult your doctor

• If your child is 5 or 6 years or older, and still bed wetting despite all your home treatment.
• If you suspect the wetting may be due to any physical problems.
• If your child wets frequently or has a burning sensation while urinating.
• If your child is dry for months and suddenly starts wetting.
• If your child shows unusual straining during urination.