As the child grows they gradually start realizing the feeling of bladder fullness. they initially learn to control and coordinate their urination and then later start controlling their stool. The urine control for daytime generally occurs at the age of 4 years. this coordination and control during the night time usually
takes longer time and usually happens between five to seven years of age.
If it’s not achieved by this age it’s called bedwetting. Its also called nighttime or nocturnal enuresis. It is a common childhood problem.
Usually, it’s not a serious illness and most children come out of this as the child grows. but it’s very distressing for children as well as for parents.
It’s more common in boys compared to girls.
Few causes of bedwetting:‐
Usually, it happens because of a delay in the maturation in one of these areas at nighttime:
* Bladder: less space in the bladder at night
* Brain: inability to wake up at the night
* Kidney: more urine production at night
And small children less than 3 years the signal pathway between bladder and and brain is immature , hence the bladder will work on its own and releases urine whenever it feels full . In the older children signals between brain and bladder are fully formed and this allows the brain to control the bladder output even during sleep
Other risk factors :‐
- most common cause is emotional stress in children . it can be a sudden event at home like death or parental disharmony or going through any major event like change of home , loss of friends, exams etc.Treating the stress can stop the bedwetting.
- * Genetics. genetics also plays a role . If one parent wet the bed after 5 years old, their Child will have 40 % chance of getting this problem and if both parents had this issue when they were young then their child will have about a 70% chance of having the same problem.
- Obstructive sleep apnea/snoring. In rare cases, bedwetting can happen if the child snores for most of the sleep time.
- Deep sleep. This cause is usually seen in the teen age group who usually have a deep sleep pattern
- Bladder or kidney disease/ urine infection. in this child will have both night and daytime symptoms.
- Neurologic disease. Rarely a spinal cord disease also can cause bedwetting. this can be diagnosed once the doctor examines the child and do some imaging etc..
- The bladder and bowels lie very close to our abdomen. Hugely loaded gut ﴾constipation﴿ can push the bowel on the bladder and cause the child to lose bladder control. Treating constipation is will treat bedwetting .
- Some medications can also increase the chances of bedwetting.
How bedwetting affects children:‐
Children may feel depressed, get embarrassed, or might develop decreased self‐esteem. This can affect the quality of life, and schoolwork. Usually, these children feel that they cannot go to overnight camps with their friends. Parents and caregivers should realize that this nighttime passage of urine is not under his or her control and they should not shame or punish the child. Instead, focus on working with your doctor to figure out the cause and taking steps that can help.
Evaluation of bedwetting :‐
After taking detailed history regarding symptoms like urninary frequency and urge , sleep pattern, bowel habits and physical examination, he might oreder some urine test or Ultrasound , and then decide management plan .
BEDWETTING TREATMENT
options in treatment include psychological counseling, education and motivational therapy, sleep pattern, lifestyle changes, drugs, and bedwetting alarms.
Bedwetting education tips for parents:‐
- Bedwetting is a self-limiting illness that takes time, in most children.
- Parents and caregivers should realize that bedwetting is not child’s fault and they should scold the child for this .parents and caregivers should encourage the child to urinate regularly during the day and also before going to sleep . if he she wakes up in night , then also he / she should be taken to the toilet .
- Avoid sugar-containing / and caffeine‐containing drinks, especially in the evening.
- Remind the child every night to get out of bed and use the toilet when he or she needs to urinate. Also, remind the child to empty his or her bladder immediately before bedtime.
- Stop using diapers, training pants, or pull‐up pants at home since these may prevent a child from wanting to get out of bed, especially if the child is older than eight years. They may be used for special occasions, such as overnight visits with family or friends.
- After wetting accidents during the night, encourage the child to go to the bathroom before changing into dry pajamas. Should leave dry lower / shots near to the bed so that child can find it easily.