Wetting the bed during sleep at night is a condition called nocturnal enuresis. This condition comes in notice when a child is 5 years or old. It is not that toilet training had gone bad. Urinary urgency, frequency or incontinence of urine may also be associated nocturnal enuresis.
Normally when the bladder becomes full it sends a message to brain through nerves, the brain then sends message back to the bladder to prevent it from getting empty automatically until the person is ready to go to urinate. Child cannot hold the large volume of urine that is produced at night. Full bladder sends a sensation but it is not strong enough to wake up your child from sleep.
By the age of 4 kids are fully toilet trained. 15-20% of kids wet the bed by age 5. Between 8-11 years of age less than 3%of children still wet the bed. Incidence of nocturnal enuresis decreases with age. In children having nocturnal enuresis with other associated symptoms treatment should not be delayed. Enuresis improves with treatment.
Factors that are involved in nocturnal enuresis:
• Defective sleep arousal
Children having problem of nocturnal enuresis have a defective arousal response during sleep. When volume of urine is large than the capacity of urinary bladder and sleep arousal mechanism is defective then bedwetting occurs.
• Nocturnal polyuria
Excessive production of dilute urine occurs at night because of altered diurnal rhythm of vasopressin secretion.
• Faulty reflexes of bladder
Involuntary urination occurs because during sleep emptying reflexes of full bladder are not adequately inhibited.
What causes nocturnal enuresis?
Exact cause of nocturnal enuresis is not known. Various factors that may be responsible for nocturnal enuresis are listed below.
• Small bladder is unable to hold the urine produced at night.
• If the nerves that control the urinary bladder mature slowly they are unable to recognize the full bladder.
• Some children do not produce enough anti-diuretic hormones (ADH) that is necessary to slow the production of night time urine.
• Stress may trigger the incidence of bed wetting.
• Consuming drinks and food that contains caffeine like chocolate, cola, coffee or tea.
• Chronic constipation is more likely to cause problem of bedwetting, because large stool in the rectum may puts pressure on the bladder.
• Urinary tract infection or diabetes also may be responsible for nocturnal enuresis.
How is nocturnal enuresis diagnosed?
In addition to physical examination, doctor will ask questions to rule out other conditions associated with the problem like medications the child is having, past health, family’s health, allergies, stress or other issues. Urine analysis or urine culture may be needed to rule out presence of any disease.
In addition to medicines how to self manage the problem of enuresis?
• Evening fluid intake should be reduced.
• Make a habit of your child to urinate in toilet before bedtime and to wake up at night to use the toilet.
• Do not blame or punish the child but reassure and encourage the child to wake up midnight to use toilet.
• Help the child in understanding the responsibility of being dry is not of parents but it is their responsibility.
• Use a reward system to encourage positive behavior. Give reward to your child every time he or she has a dry night. This will encourage him or her to use toilet at night.
