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Bed Wetting |
Enuresis or bed wetting is the involuntary passage of urine beyond the age
of
anticipated control that is usually 5-6 years. 15-20% of children 5 years of
age wet their beds. Nearly 5% of 10 year olds will wet, and 1% of adolescents
and adults continue to wet. It is twice as common in boys as in girls.
Bedwetting also seems to run in families. |
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Types of wetting problems
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Primary enuresis means that the child has been wet from the beginning, whereas secondary enuresis means that the child had been
dry earlier and has now started wetting. The latter condition could be due to urinary infection, diseases like diabetes, structural
abnormalities in the urinary passages or stressful situations at school or at home like divorce, demanding parents or the arrival of a
sibling. |
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Commonly, wetting at night is the only symptom, but some children also have frequent urination during the daytime with occasional
wetting. It has been seen that children who are constipated are more likely to have enuresis. |
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The good thing is that a large number of children stop wetting as they grow up. But during the
time that they are wetting, the social costs are enormous. These children need all the support
and compassion from their parents and the care givers. Other methods that often help include: |
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Behaviour modification techniques such as rewarding the child for remaining dry at night. The rewards may
increase in value with each passing dry night. It is inappropriate to punish the child for a wet night. In fact,
punishment worsens the situation. |
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Fluid intake should be limited from the evening so that the child produces less urine. Sometimes this regime may be harsh to enforce on children. |
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The use of alarm devices is beneficial. These alarms use a pad inserted into the child's underwear, so that as
soon as the pad gets wet an alarm bell rings waking the child up before the bladder empties completely.
This conditions the voiding mechanism in several children. Unfortunately, good quality alarms are not
available in India. |
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Counselling of the child and the family may be necessary in case an underlying emotional or interpersonal problem is suspected. |
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Most successful treatment programmes require a multifaceted approach. Often a combination of techniques gives better results. In case of relapse after stopping treatment, the regimen may need to be started all over again. Success in treatment depends on a motivated child and dedicated and compassionate parents. |
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In older children, and in those who fail to respond to the above methods of treatment, medicines may be prescribed. Imipramine is a commonly used drug that is normally prescribed for the treatment of depression in adults. It helps correct bedwetting in about 30% of
children and needs to be given for 4-6 months. The side effects of imipramine include sleepiness and mood changes. Another
medicine called desmopressin, that is a derivative of the hormone vasopressin also helps in about 30% cases. This drug is given as a
spray into the nose. This latter drug is expensive. |
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