Bed Wetting Eneuresis

Bed-wetting in children below 7 years is just a developmental stage, but above 7 years of age needs treatment. Bed wetting if untreated can go on for years. It is reported that 13% of bed-wetting is seen in 6 year olds while 5% is seen in 10 year olds. It is mostly seen in boys.

Statistics reveal that around 5 million children in the United States have Enuresis or bed-wetting during the nights.

A family history of bed-wetting by both parents as children puts the child at 80% risk of developing enuresis. It is seen more in boys and more common in children with Attention Deficit Hyperactivity Disorder.

Causes

Many causes can lead to bed-wetting.

  • Improper development of child’s urinary bladder

  • Inability of the urinary bladder to hold urine during night times

  • Immature nerves of the bladder

  • Situations that cause stress to the child like joining a new school.

  • Staying away from home

  • Arrival of a newborn sibling in the family

  • Less production of anti diuretic hormone that slows urine production during night times

Other symptoms include:

  • Sleep apnea (child’s breathing interrupted in sleep)

  • Urinary tract infection

  • Diabetes

  • Chronic constipation

  • Abnormalities in spinal cord

  • Defects in urinary system or neurological system

One should consult the doctor if the child is wetting the bed even at 7 years of age, the child is complaining of pain or burning sensation during urination, swelling of feet and ankles is seen, the child is wetting his pants even during the day or if child is misbehaving at school.

Diagnosis

  • The doctor does a general physical examination of the child.

  • A history of bed wetting, meal times and sleep time is noted by the doctor.

  • To check if there is any urinary tract infection or diabetes, urine analysis is done.

  • If any problem in the bladder or kidney is suspected, x-rays and imaging studies are done.

Treatment

If bed wetting runs in the family, then the child will stop it at the same age when the parents did when they were children. The level of treatment depends upon how the child is feeling about bed wetting. If the child is embarrassed about wetting the bed, a more aggressive treatment is given by the doctor.

A battery operated device known as moisture alarm that detects moisture can be purchased from the local pharmacy. This device is connected to a moisture sensing pad attached to the pajamas of the child. The minute the child starts urinating, the wetness causing the device to sound an alarm which wakes the child up or the parent in time so that the child can urinate in the toilet. One need to be patient when trying out the moisture alarm which gives good results after 12 weeks.

If the doctor finds that the bladder is too small, then to increase the bladder capacity medications like hyoscyamine (Levsin) or anticholinergic drug like Oxybutynin (Ditropan) is prescribed. The side effects that can occur include flushing face and a dry mouth.

To increase the level of Antidiuretic hormone that helps in making less amount of urine during the night, the drug prescribed is desmopressin. This drug however should NOT be given to the child when he or she has taken lot of fluids or the child is feeling nauseous with a headache. The most serious side effect of this drug is a seizure.

To change a child’s sleeping and waking patterns, an antidepressant drug known as imipramine (Tofranil) is prescribed. An overdose of this drug can be dangerous hence it is prescribed only when other medications fail.

Coping and support

One should never punish a child for bed wetting as it is an involuntary action and not intended by the child. If the bed wetting is due to some stress factor one should talk to the child and calm his or her fears.

For easy cleaning, it is recommended that the mattress be covered with a plastic cover. The child should be made to wear absorbent underwear that absorbs urine well.

Night-lights along the way to the bathroom will help the child reach the bathroom without tripping in the middle of the night.

One should avoid giving children drinks like cola, chocolates and snacks with caffeine in the evenings as reports say that they increase urination.