Bed-wetting

Bedwetting (Nocturnal Enuereis)

Bedwetting, also called nocturnal enuresis, occurs when a child accidentally passes urine at night during sleep, after the age that he would be expected to be dry. It is not something that the child does on purpose.  Doctors often separate bedwetting into two types, primary enuresis and secondary enuresis.  In primary enuresis, the child has never been dry at night.  In secondary enuresis, the child was dry at night for one year but has suddenly and unexpectedly started to wet the bed again.  In general, boys are about three times more likely to have problems with bedwetting than girls and the problem tends to run in families.

Primary enuresis (never being dry) is probably caused by some delay in a child’s development, since the percentage of children with this type of bedwetting decreases with age.  At age 5, the % for males is 7% and for females 3%; at age 10 the % for males is 3% and 2% for females.  One % of males at 18 is still enuretic.  Persistent bedwetting may be the result of inadequate and inappropriate toilet training.  Psychological factors may play a part, especially if the child spent his toddler years living through times of unusual stress.  Children of immigrants, children who live in overcrowded conditions and those who come from families with psychiatric illness are all at risk from primary enuresis.  Some experts believe that primary enuresis is related to a slower development of nerves and brain centre that allow a child to control urination.  Others believe that the child’s bladder may be smaller than normal for size.  Still others blame a reversed pattern of urine production, so the child’s body makes more urine at night than during the day.

In secondary enuresis (bedwetting after being dry), stress is often to blame, although it is important to exclude a urinary tract infection.  Usually the child begins bedwetting when a sudden change occurs in their world. Almost any change in the environment, good or bad, can be a trigger.  This includes a new baby, a death in the family, parental or marriage problems, a new home or school.  It may be related to sexual abuse.

What to look for

In most children with bedwetting, soaked sheets and wet pyjamas are things that parents will see.  Still, it is wise to look for signs of a urinary tract infection.  He may urinate more often than normal during the day or complain of an uncomfortable or “burning” feeling when urinating, and the urine may look cloudy or have a very strong smell.  Other symptoms include fever, chills and pain in the back or lower abdomen.

 

 

 

 

What to do

If your child is younger than 6 years old, just give him time.  Let him know that about 1 in 5 of his classmates have the same problem and that almost all children outgrow bedwetting before the age of 10.  To help your child achieve his first dry night, try these suggestions :-

·      Encourage and praise him for dry nights.  Never punish, scold or blame.

·      Remind your child to urinate before going to bed.  If he doesn’t feel the need to urinate, tell him to “try” anyway.

·      Limit liquids in the last two hours before bedtime.

·      Use real cloth underwear rather than nappies or plastic pants.  “Grown-up” or “trainer” pants help remind your child to stay dry.

·      To make clean up easier, use plastic sheets or place a large plastic bag under cloth sheets.

If your 6 year old is still bedwetting, you may want to ask your doctor for suggestions.  By this age, most children can use an incentive with gold stars or small rewards for each dry night.  During the day your child can practice holding his urine for a few extra minutes rather than running to the bathroom right away.  He can also try starting and stopping his stream as he urinates, to help strengthen and control muscles around the urethra.  By this age, your child can help with a morning clean up after a wet night.  This is important as it empowers him.

After age 7, your doctor may recommend a personal enuresis alarm.  An alarm uses sounds or vibrations to wake your child if he wets his underwear.  It is important that he wakes up completely and quickly as soon as the alarm rings so that a conditioned response develops between having a sensation of urine in the urethra and waking.  This will require you to wake him as soon as you hear the alarm.  Some doctors prescribe a nasal spray or oral Desmopressin at night, a drug that is similar to the body hormone that switches off urine production.

Call your doctor if

Your child is wetting the bed at night and is age 6 or older, and never had a dry night, or started bedwetting after having many dry nights.  Also call your doctor if your child has pain, discomfort or a “burning” feeling when urinating, has urine that is cloudy or smelly, has a fever, chills, pain in the back or abdomen or often runs to the bathroom during the daytime and always seems to be thirsty.