Dr. Manas Sharma, Dr. R. B. Nerli, Dr. Shridhar C. Ghagane, Neeraj S. Dixit – Dept. of Urology, KLES Kidney Foundation, Dr. Prabhakar Kore Hospital, Belagavi.
Bedwetting, also known as nocturnal enuresis, is an uncontrollable leakage of urine in discrete amounts while asleep. Nearly half of the parents of such children do not seek help since many parents believe that their child will eventually outgrow the problem. The parents should realize that bedwetting is nobody’s fault, and no child wets the bed on purpose. It is a widespread medical condition. A wet bed is nothing to worry about until the age of five. But it is a matter of concern when a child older than five years wets the bed at least twice a month.
World Bedwetting Day: The concept of World Bedwetting Day was first launched in the year 2015, it is observed on the last Tuesday in May. This initiative is aimed to raise awareness in the community about this common medical condition and encourage families to discuss their concerns without any embarrassment or guilt with the doctors and health-care professionals.
What is the impact of bedwetting on children and parents?
Children with this problem tend to feel ashamed, often isolate themselves and avoid social situations like missing out on sleepovers at friends’ houses and school trips. Bedwetting can also harm a child’s school performance. Children may suffer from a feeling of low self-esteem at an age when self-image is extremely important for optimal personal development. Leaving it untreated for a long time can cause social and emotional issues in the family.
What are the causes?
For decades, bedwetting was considered as a simple condition that was thought to resolve naturally. However, it is now viewed as a complex problem, including several factors. It is best considered as a symptom that may result from a combination of three different predisposing factors:
1. Sleep arousal difficulties: a reduced ability to wake to noise or bladder contraction.
2. An abnormally large volume of urine production at night (nocturnal polyuria).
3. Bladder dysfunction: small bladder capacity or overactive bladder.
Is there any familial association?
There is often is a strong familial association of bedwetting. If none of the parents has suffered from bedwetting, the child has only a 15% chance of bedwetting. If one of the parents has suffered from bedwetting, the chance of bedwetting increases to 44%, and if both parents have been affected, then the probability increases to 77%.
What are the treatment options?
It is advised that the parents of children who wet the bed consult their doctor as early as possible to discuss possible causes and treatments to reduce the impact of bedwetting. Before introducing any form of therapy, it is of utmost importance to explain the bedwetting condition to the child and the parents to demystify the problem. Retaliatory measures, like expressing anger, negativity, or blaming the child, are strongly discouraged.
• Lifestyle Modifications: The child should be encouraged to drink 6-8 water-based drinks per day. These should not include fizzy drinks (cola, sugary beverages), which can be an occasional treat. Drinks containing stimulants like tea and coffee are also to be strictly avoided. Timing of dinner and last liquid intake should be fixed to at least 2 hours before sleeping time. Immediately before going to bed, the child should void urine. Sleeping in a dark bedroom, avoiding electronic devices (television, iPad, mobile phones) before sleeping and keeping a routine of a regular bedtime increases the child’s chances of staying dry.
• No “night-time nappy” trial: Occasional use of diapers is acceptable to avoid an embarrassing situations like bedwetting on a vacation, school trips, etc. However, daily use of night-time diapers at home is strongly discouraged. Once the general lifestyle modifications are brought into practice, giving the child a no “night-time nappy’ trial for 3 to 4 days can also help them overcome bedwetting. If they stay dry, try a more extended trial until they are regularly dry at night.
• Reward system: Many children need some reassurance to help themselves become dry. Rewards can be given for drinking the right amount of fluids throughout the day and using the toilet before bed. However, it is essential to note that rewards should not be given for having a dry night, as this is something your child cannot control consciously – instead, the child should be praised for dry nights.
• Nightly “wetting alarm” treatment: The nightly alarm treatment is the use of a device that is activated by getting wet. The aim is that the child wakes up by the alarm either by itself or with the help of parents. The method of action is to repeat the awakening and therefore change the high arousal to a low arousal threshold.
• Medical Treatment: In proven cases of nocturnal polyuria (increased night-time urine production), drugs (desmopressin) can be prescribed.
