Bed-wetting is one symptom that both the parents and the young sufferer face in life. At the same time, the problem is too sticky and troublesome to brush under the carpet.
The medical term for bed-wetting is enuresis. It means involuntary voiding of urine after the age of achieving adequate bladder control. Bed-wetting mainly occurs at night, it is called nocturnal enuresis. When it occurs mainly during the day, it is called diurnal enuresis.
Up to the age of 4 years, as many as one in four children wet the bed occasionally. Only after that age, the reasonable bladder control achieved. Boys take even longer to achieve this control. So, most experts consider bed-wetting significant only if it continues after the age of 6 years. When the child has never achieved adequate bladder control, bed-wetting is said to be “Primary” and when the child achieved good bladder control for six months or more and then lost it, it is called as “Secondary”
More than 85% of cases of bed-wetting are nocturnal and primary, and almost 99% of such patients have no underlying disease. I will limit the discussion to this particular type of enuresis.
Primary, night-time bed-wetting
Causes
This type of bed-wetting is a developmental problem in which the brain takes more time to mature in this particular respect. The immature brain fails to recognize the full bladder’s voiding signals during sleep, which is why these children fail to wake up to urinate.
Smaller bladder capacity and deeper sleep patterns have been observed in children who suffer from the problem. Genetic factors also involved, considering that many cases show a familial tendency.
Psychologically stressful events like a death in the family, the birth of a sibling, or a move to another place were once considered very important in the causation of enuresis. But it is now thought that such stress is mainly responsible only for the secondary type of bed-wetting.
Other Conditions
Involuntary urination may cause by other conditions such as urinary infections, congenital abnormalities of the urinary tract and the spine, diabetes, excessive water intake, and constipation.
A visit to a pediatrician and a urine test is usually enough to diagnose and distinguish these conditions. Only occasionally are x-rays, ultrasonography, and blood tests necessary.
Management
Managing a child with primary, nocturnal enuresis is a difficult and long process. As in any such complex disorder, patience, persistence, and perseverance needed.
Ensure that the affected child participates actively in the management program. Make the child feel responsible by encouraging her to keep a record of dry and wet nights. Involve the child in the cleaning and changing of the soiled bed sheets but do so gently and tactfully.
Parents should try to preserve the child’s self-esteem, which is the first casualty of this symptom. Shouting and punishments achieve nothing. Parents must understand that the child is not doing it deliberately and that it is just a matter of time before she gets it right. A reward system for dry nights (as simple as stars on a star chart) often works wonders for the child’s motivation.
Some Routine Measures that help are:
. Compulsory urination before going to bed
· Decrease water or fluid intake close to bedtime
· Avoid to drink things like tea, coffee, chocolate, or fizzy drinks close to bedtime
· Improve access to the toilet, sometimes keeping a potty near the bed
· Don’t use diapers as an easy way out, it hampers learning.
Behavior Modification
It should aim to make the child realize that she should not be trying to hold off the urine throughout the night but rather should get up, go to the toilet, and urinate there when she feels the impulse.
This patient self-awakening program uses techniques like progressive behavior modification and self-hypnosis; in the latter, the patient imagines having a night free of bed-wetting. This method, when successful, has the lowest relapse rates.
Sometimes this method is combined with a parent-awakening program in which the parent wakes up during the night. It is not to carry the child to the toilet but just to wake her up and make her go to the toilet to urinate.
Bed-wetting alarms are small, wearable alarms. When the patient starts to wet the bed, the alarm starts to buzz by detecting moisture. These alarms have a success rate of 70% in curing the condition and a low relapse rate. But for this therapy to be successful, it requires motivation from the patient and parents and a trial of at least 23 months.
A particular antidepressant, which helps to relax the bladder. A synthetic form of a hormone (which helps to concentrate and reduce the volume of urine) are the two most popular medication options for bed-wetting.
Neither medicine gives a complete cure & both have a high (>90%0 relapse rate. They are useful in combination with other techniques and as a short-term benefit in certain situations like school trips and scout camps.
Final Word of Advice
Self-motivation, a supportive parental attitude, and a self-awakening program- with the aid of bed-wetting alarms and short-term judicious use of medicines the answer to this tricky problem.
Many less motivated parents and patients lose heart midway through this long-drawn battle, may riddle with shame, guilt, and frustration.
So hang in there; time will cure it.