Bed-Wetting or Nocturnal Enuresis- Definition, Causes, and Treatment.

Bed-wetting – Definition

Enuresis is the clinical term for bed-wetting. It is the involuntary urination during sleep after the age four or five when a person should be able to control the bladder. Infants and children’s will do unintentional urination, it is more normal for them.  Many children’s achieve daytime control but not in the night time. The bladder control varies depending upon age. Some parents expect dryness at an early age. When the child is capable of holding the bladder but urinates unfortunately while sleeping is called nocturnal enuresis.

Bedwetting

Prevalence

Enuresis is one of the most prevalent and frustrating disorders of childhood. A child expected to sleep dry at night time without making wetting the bed between the ages of 2 and 4. However, at age four, 25% of children still wet the bed; at age five, 20%; at age six, 15%; at age ten, 8%; at age fourteen, 4%; and at age eighteen and over, 2% of the population are still bed wetter’s.

Types of bed-wetting

There are two main types of nocturnal enuresis such as

Primary bedwetting: Bedwetting since from the early stages of the child. The child not yet achieved nighttime dryness over a period of six consecutive months.

Secondary bedwetting: bed wetting that begins after the child has been dry at night for a significant period of time, at least 6 months.

Risk factors

Risk factors for the cause of enuresis include:

• Family history plays a role in enuresis
• Chronic constipation
• Sleep apnea
• Urinary tract infection
• Intake of excessive water content foods before bedtime
• Medical conditions such as abnormal function of kidney or bladder or neurological system
• Attention Deficit Hyperactivity Disorder (ADHD)
• Some medications may trigger enuresis
• Sexual abuse

Causes of bed-wetting

Doctors do not know the actual cause for nocturnal enuresis. But there are various developmental conditions include:

Hormonal problem: A hormone called antidiuretic hormone causes the body to produce less urine at night time. In some cases, the human body does not produce the ADH hormone and results in the increased production of urine when the person is sleeping.

Genetics: Teens with enuresis often have a Parent who had the same problem at about the same age. scientifically identified the specific genes that cause enuresis.

Sleep problems: sometimes deep sleep may cause enuresis that they don’t wake up when they want to pee. Sometimes bedwetting is the sign of obstructive sleep apnea.

Bladder problem: Your child may have a small bladder or not developed properly. This cannot be able to hold urine which is produced during the night.

Caffeine: Caffeine can cause a person to urinate more.

Medical conditions: Some medical conditions may also cause secondary enuresis. Medical conditions include diabetes, urinary tract abnormalities (problems with the structure of a person’s urinary tract), constipation, and urinary tract infections (UTIs). Spinal cord injury may also play a role in enuresis. But it is rare.

Psychological problems: Some doctors believe that stress or tension can be associated with enuresis.

Symptoms

Many people will wet their bed only at night. They will not have other symptoms than bed wetting. But some physiological problems with nervous system or kidney may cause the signs and symptoms.

• Bedwetting during the day
• Frequency, urgency or burning during urination
• Dribbling, straining or other unusual symptoms of urination
• Being unable to control bowel movements
• Constipation

Frequency of urination will vary from children to adult

• While adults may urinate only three or four times in a day, children urinate frequently more than adults, in some cases, they may urinate 10 to 12 times a day

Complications of bed-wetting

Bedwetting can create some issues for your child including

• A person cannot go to trip or stay outside home for social activities such as sleepover and camp
• Rashes may occur in the bottom or in genital area due to sleep in wet underwear for  a long time
• Bedwetting can lead a person to feel low self-esteem, guilt, and embarrassment

Diagnosis and test

Your doctor may ask questions about your symptoms, your past health history, family history and other medical problems. A doctor may recommend the following to identify the cause of bed wetting.

• Urine test to find any signs of an infection or diabetes
• Physical exam
• Discuss family history, symptoms, fluid intake, bowel and bladder habits, and problems associated with bedwetting
• Imaging tests such as X-Ray or MRI of kidney or bladder to look at the structure of urinary tract

Treatment and medications

Your doctor can do several things to treat bedwetting based on what caused it.  The most often treatment for enuresis is behavioral modifications.

Bedwetting alarms: To treat bed wetting in teens, various types of bedwetting alarms are available. Most of the persons respond to the alarms and make them go toilet. These alarms will go on when the person begins to wet on the bed. By this alarm, a person can sleep without wetting the bed too much. If it’s been doing for years, automatically you can train yourself to wake up or to hold your urine until morning.

Bedwetting alarm

Manage what you eat and drink before bed: People who with enuresis can manage their food and drinks before sleeping. By going toilet before going bedtime can reduce the bed wetting. Avoid certain foods in the evening which can irritate the bladder include such as tea, coffee, chocolate, sodas and other carbonated beverages containing caffeine.

Imagine yourself dry: Positive imagery can make you dry during the night, where you think about waking up dry before you go to sleep, can help some people stop bedwetting. Some people find that rewarding themselves for waking up dry also works.

Acutreatment: water imbalance can also cause the bed wetting. It can be balanced by doing acupressure treatment. Massaging the pressure points in the body that belongs to water balance points are shown in the figure.

Pressure points for bed wetting

Medical treatment

Bedwetting that caused from other medical conditions can be cured by doing medications. Medications can treat the variety of which bedwetting is a symptom. For example:

• The drug desmopressin (DDAVP) and imipramine (Tofranil) reduces urine production at night. It is given orally or as a tablet but only for children more than 5-year-old.
• If your bladder is smaller, an anticholinergic drug such as oxybutynin (Ditropan XL) can be used to reduce bladder contractions and to increase bladder capacity. It is used along with other medications and it is generally recommended when other treatments have failed.

Prevention of bed-wetting

• Parents should encourage child by being positively and should make them understand how the bedwetting will affect his or her social life
• Wake up your child several times to go to toilet for urination
• Encourage your child to urinate before bedtime and several times in a day, that makes your child as routine habit
• Avoid beverages and food that contain caffeine before bedtime