Reena Mistri, a brand manager with an advertising agency, was a worried mother. Her five-year-old son, Akash, continued to wet his bed till the age of four years. At first, Reena thought he would outgrow it but when it showed no signs of stopping, she became troubled. It was only after consulting a doctor and taking appropriate measures that this problem was solved.
Bedwetting is a common childhood phenomenon. It is often only a stage in the development of a child. It refers to urinary incontinence during sleep in children who are older than 5 years. While it is a cause for concern amongst parents, bedwetting or nocturnal enuresis as it is commonly called, can often be extremely embarrassing for the child himself, especially if he has started going to school.
Around 80 per cent of bedwetting cases are seen in children who have not achieved night-time bladder control (or primary enuresis). In the remaining 20 per cent of cases, bedwetting starts after the child has been dry at night for at least six months (secondary enuresis). This is usually caused due to a stressful event in the child’s life like a family conflict, divorce, birth of a sibling, etc.
Generally, most children achieve daytime bladder control by the time they are four years old. They are expected to achieve night-time bladder control by 5-7 years of age. If the child continues bedwetting beyond the age of seven, it could be a sign of an underlying medical problem with the urinary bladder or spinal cord, and would require further tests.
Signs of bedwetting:
As a parent, you should be on the look-out for signs such as increased thirst, increased frequency of passing urine, urgency, straining (applying pressure to pass), dribbling of urine, weak urine stream, pain after passing urine, constipation or soiling of clothes due to stools (encopresis), etc.
If your child shows such initial symptoms, you should immediately consult a paediatric nephrologist or a urologist to avoid any further complications. After consulting an expert, it would be helpful if you maintain a voiding diary (timing of daytime voids, volume of urine passed). Following this, a urine analysis should be done to check for urine infections or glucose in urine. An ultrasonography can be done after this, if the paediatric nephrologist/urologist recommends it.
If your child doesn’t show any such symptoms, his bedwetting could be due to any of these causes:
1. His bladder muscles may be developing more slowly than usual
2. His bladder holds a smaller than normal amount of urine
3. His body makes a lot of urine
In most children, bedwetting usually goes away on its own as the child learns to control her bladder. However, if the problem persists, it can be distressing for the child and her parents.
Bedwetting is normal in children. However, if it continues beyond a certain age, it might be a cause for concern. This ClipBook looks at some home remedies for bedwetting.
Bedwetting is twice as common in boys as in girls. Also, children whose parents have a history of prolonged night-time wetting, have more chances of bedwetting. Treatment options are considered for children who are over 7-8 years old. The treatment method is usually determined based on the extent to which the bedwetting bothers the child and the family. Motivating the child to quit bedwetting is an important part of the treatment. Otherwise, other treatment methods might not work.
Here are some tips you can use to stop your child from bedwetting:
- Make sure he has passed urine before going to bed: Before your child goes off to sleep, ensure she has used the restroom so that she won't have to wake up at night as a result of bedwetting.
- Set reminders during the night to wake your child up and ask her to pass urine: Another way to try and curb the bedwetting habit would be to set reminders during the night, which would enable your child to get up and use the restroom.
Note: This method might hamper the sleep of the child though.
- Make sure the child doesn’t take too many fluids in the evening: Before bedtime, cut down on the fluid intake of your child for this might only lead to a tendency to pass urine.
- Don’t use diapers or training pants regularly for your child if he is over 5 years old: We often tend to use diapers to combat bedwetting in children. However, diapers are meant for a certain age group. If you continue to use diapers for children older than two years, he might not try to combat bedwetting and take the easy way out via diapers.
- Do not mete out punishment: Make sure you don’t punish your child for bedwetting as it is not his fault. This will make them see bedwetting as something wrong and they may have difficulty trying to combat it.
Enuresis alarms are the most effective method for controlling bedwetting. You can consider trying the alarm therapy three to six months after your child is provided with behavioural training techniques, and before you resort to treatment with medicines.
These alarms work by using a sensor that detects the first drops of urine in the underwear. When the sensor is activated, it sends a signal to an alarm device, which wakes the child up with a sound, light or vibration. The alarm helps to train the child to wake up or stop urinating even before it goes off.
For children in the age group of 5-15 years, the frequency of bedwetting is as follows:
5 years: 16%
6 years: 13%
7 years: 10%
8 years: 7%
10 years: 5%
12-14 years: 2-3%
15 years: 1-2%
Medication for bedwetting:
There are medicines that reduce urine production. Children who are prone to bedwetting are advised to take them at bedtime to reduce the amount of urine made during sleep. They are generally recommended for a brief period, for instance, when the child is going for an overnight camp or a sleepover. However, they can also be used on a nightly basis.
It is recommended that the treatment is continued for 3 to 6 months, with gradual tapering off over the next 3 months to decrease the possibility of a relapse after the medicine is stopped. Such medication should be given only on prescription by the paediatrician and after a discussion about the side effects and the risk of relapse rates. Remember, it is important to take your child for regular consultations to an expert while he is undergoing treatment.
In the video below, Dr Cathrine Neilsen-Hewett, who is the Academic Director of the Early Years at the University of Wollongong, looks at what causes bedwetting in teens.
Bedwetting can be traumatic for the child and worrying for the parents. So make sure you seek expert advice if it persists.
The author is a Paediatrician with special interest in Paediatric Rheumatology, Columbia Asia Hospitals.
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